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Page 1 of 6Page 1 of 6CHARLOTTE-MECKLENBURG SCHOOLSPROCEDURES FOR ENROLLMENTForm 725110.1Enrollment forms may be submitted to Student Placement - Smith Family Center, to any CMS school or anyCMS Learning Community Office. After the enrollment deadline for the second lottery, students must submitenrollment forms directly to their home schools. (Lottery dates are available on the Student Placement andMagnet sections of the CMS website.)In compliance with North Carolina law, students must be 5 years of age on or before August 31 to beconsidered for Kindergarten. Students applying for any Pre-K program must be 4 years of age on or beforeAugust 31.The following documents are required for enrollment: Student Enrollment Form Proof of date of birth and legal name (see page 2) Proof of Residency (see page 2) Safe Schools Declaration Current Immunization Record* All children entering NC public schools for the first time must submit proof of aHealth Assessment.**These documents are required upon student entry. A “30 calendar day grace period” for submission isgranted for students not having required documentation.For more information contact the following: Guardianship questions should be directed to Student Placement at 980-343-5335. Questions about students with special needs should be directed to the Programs forExceptional Children at [email protected] or 980-343-6960. Students whose primary language is not English should contact the InternationalCenter at [email protected] or 980-343-3784.Student Placement is located at1901 Herbert Spaugh Lane, Charlotte NC 28208Programs for Exceptional Children is located at4421 Stuart Andrew Boulevard, Charlotte, NC 28217The International Center is located at4000 Applegate Road, Charlotte NC 282097/201412/2017

Form 725110.1Form725110.1Form 725110.17251001Form 7251001Form 7251001Form OOLSREQUIREMENTS FOR ENROLLMENTPage 1 of 6Page 21 ofof MENTS FORFOR ENROLLMENTENROLLMENTREQUIREMENTSSchoolsFOR ENROLLMENTBefore any student is assigned to attend Charlotte-Mecklenburg(CMS), the student’s parent, legal guardian or te- algguardianor guardianor requiresadditional documentationfrom((CMS),a courtttheor sstudent’sagency)mustprovideproofof datebirth,Beforeanynysstudenttudentoriss aassignedo aattendCharlotte- ‐Mecklenburgharlotte- sassignedtoattendCharlotte- cy)mustprovideproofofdateoprooflegal name,oproofof legal residencein MecklenburgCounty, currentandNCprovideforof(legalofguardianshipr sponsorshiprequires additionaldocumentationfrom aimmunizations,court ecklenburgCounty.prooflegalname,of legal residenceMecklenburgCounty, currentNCprovideHealth onsorshiprequiresaindditionaldocumentationfrom aimmunizations,court esidenceMecklenburgstudentstoaaandNCpublicschool. iinandllegalegal studentstoaandNCpublicschool. mentsustbeOne ((1)of ttheOne1) ofheffollowingollowing documentsdocuments mustmust bebeshown:shown:One(1) ofthefollowing wn:q q q q q q q q q q q q q q q q q q q q q bOriginalorphotocopyOriginalOriginal catePassportPassportPassportPassportState- ‐issuediidentificationdocumentPassportState- ‐issueddocumentState-issueddocumentState- SDepartmentofState(I- ‐94Arrival/DepartureState- (I- entDepartmentofofStateState(I-94(I- fState(I- alLocal ernationalCenterat980- ‐343- heInternationalC80- ‐343- Centerentera980-343-3784t9enterat980- ‐343- optionInternationalCenterat980- ‐343- offAAdoptionDecreeAdoptionDecreeofofAdoptionq Student’sdriver’slicensellicense Student’sq Student’sdq enseicense Student’sdriver’sLifeinsurancepolicyq Student’sdriver’slicense Lifeinsurancepolicyq Lifeinsurancepolicypolicyq Lifeinsurance dottheq Lifeiinsurancensurancepolicy Acertifiedcopyofmedicalthechild'sq he hild'shild'sq alrrrecord etreatingphysicianorthehospitalinq ssuedbythetreating physicianphysician ssuedbybythethe treatingtreatingphysicianorthethe q n Aq Aertifiedopyobbq icateertificateissuedissuedssuedbybyya giousiinstitutionq oremple, membersembersthatmaintainsmaintains atq ainsbvirthrecordsofriecordstsmembers q Previouslysschoolq srecords Previouslyq idencyForProofofResidencyForProofofResidencyONE (1) of the following documents must ocumentsmust beshown:mostCopy of residential leaseONEq entialdeedORmrecordmostq CopyCopyfresidentialleasemostoforesidentialleaseq q q q q q q ORrecordrecord ntialdeedORrecord wingcolumns:q q q q q q q q q q q q q q q q q q withinithintthehe pastAnyONEutilitybillbilloororkorderdastAnyONE iutilitybilloas,rwwworkorderdatedtwwithinthe leValidNorthCarolinaDriver’s thehepastdowDatedwithinithinpast ayrolltubo PayrollStuboBankStatementPayrollStuboo oardSSStatementtatemento CreditCredit CCardtatemento CreditCardStatementONE (1) of the following documents must be stbeLetterfromapprovedagency (grouphome)ONE : Letterfromapprovedagency(grouphome)ONEq oftheromfollowingdletterocumentsmusthome)be shown:Letteraagency (1)Refugeeq Letterffresettlementromaapprovedpprovedgency statementHUDclosingstatementHUDclosingstatementq q q q q q q Current Vehicle atedwithin tYearoVehicleTaxBillo rtyo W-2PropertyTTaxaxBBillilloW- ‐2W-2PropertyTaxBilloW- ‐2o W- ‐2oMedicaidCardW- ‐2oo MedicaidMedicaidCCardardo MedicaidCardORORORORORq Letterromaagencygrouphq y ((grouphome)ome) letterq (grouphome) CopyoffCharlotteHousingAuthorityleaseq Refugeeesettlementetteretterq Refugeeresettlementletter teHousingAuthoritylleaseq Refugeeesettlementletterq CopyharlotteHousingAeaseThesefor addressverificationmust reflect the current address for enrollment or change of address. CMS has anq rityandleaseeaseq tscanbe ormoreinformation.StudentPlacementat980- ‐343- ‐5335ortheInternationalCenterat980- ‐343- ttoheenter80- ‐343- ‐3784fforinformation.oreinformation.residency policynot apply toCas definedby theMcKinney---Vento Act.StudentPPlacementlacementaaThist9980- ‐343- ‐533580- ‐343- essenteraatt99students,80- ‐343- ‐3784ormmoreoreinformation.residency policynot apply toChomelessas definedby theMcKinney---Vento Act.StudentlacementaThist980- ‐343- [email protected],80- ‐343- ‐3784formoreinformation.ForPmoreinformationvisit www.cms.k12.nc.us,emailor call omelessstudents,asdefinedbytheMcKinney- ‐VentoAct.For more [email protected] call dents,sdefinedyheMcKinney- efinedbthey ttheMcKinney- us,[email protected] ‐343- udents,asdefinedbytheMcKinney- .nc.usorcallall980- ‐343- ‐53359A80- ‐343- ‐53357/20147/201412/2017For vmorevisit www.cms.k12.nc.usor call 980-343- tioninformationall980- ‐343- ‐5335980- ‐343- [email protected] ‐343- ‐5335EveryChild. EveryDay. Fora BetterTomorrow.EveryEvery Child.Child. EveryEvery Day.Day. ForFor aa BetterBetter Tomorrow.Tomorrow.

Page 3 of 6CHARLOTTE-MECKLENBURGSCHOOLSCharlotte-Mecklenburg SchoolsSTUDENTENROLLMENTSTUDENTENROLLMENT FORM FORMForm 7251001Form 725110.1Student InformationStudent’s Legal Last NameSatisfactory proof of age, legal name and residency must be submitted at the time of enrollmentStudent’s Legal First NameStudent’s Legal Middle NameStudent’s Preferred NameAddressApartment NumberCityStateHome Phone MaleZip CodeCell PhoneDate of Birth (mm/dd/yyyy)SexPlace of Birth (city, state, county, or country) FemaleWhich category best describes the student’s race? American Indian or Alaskan Native Native Hawaiian or other Pacific IslanderWho does the student live with? (Name and Relationship)Is the student Hispanic or Latino? Yes NoFamily InformationParent 1 Last NameAddressParent 1 First NameParent 1 Middle Name Black or African AmericanParent 1 Maiden Name (If applicable)Deceased Yes NoApartment NumberStateZip CodeEmployerEmailHome PhoneCell PhoneParent 2 Last NameParent 2 First NameBusiness PhoneParent 2 Middle NameParent 2 Maiden Name (If applicable) same as aboveDeceased Yes NoApartment NumberCityStateZip CodeEmployerEmailHome PhoneStepparent Last NameAddress Asian White same as aboveCityAddress7/2014Cell PhoneLegal Guardian Business PhoneSponsor Information First Name(check if applicable)Middle Name same as aboveCityEmployerRevised 7/2014RelationshipApartment NumberStateZip CodeEvery Child. Every Day. For a Better Tomorrow.Email

Page 4 of 6FormForm 72510017251001Form7251001FormForm 72510017251001CHARLOTTE-MECKLENBURG SCHOOLSStepparent, Legal Guardian Sponsor llPhoneStepparent,Legal GuardianGuardian SponsorSponsor PhoneCellHomePhoneCell PhonePhoneHomePhonePhone((Home Phone))(Cell))CellPhone(Phone(Home Phone))(Cell))(()()OtherOther childrenchildren inin thethe familyfamily enrolledenrolled inin CMSCMSOtherchildrenin thefamily enrolledin CMSOtherchildrenLegalNameOtherchildren inin thethe familyfamily enrolledenrolled inin CMSCMSLegalNameLegal NameNameLegalLegalNameLegal NameLegalNameLegalNameLegalNameLegalNameLegalLegal NameNameLegalNameLegalLegal NameNameLegalNameLegalLegal NameNameStepparent,Guardian Sponsor pparent,Legal Guardian Sponsor Information—ContinuedENROLLMENT ationHealthInformationListpertinenthealth ormedical informationand instructions:HealthInformationListpertinentList pertinent healthhealth oror medicalmedical informationinformation andand essPhoneBusinessPhone(Business)) PhonePhone(Business(Business)(()) adeListpertinent healthor medicalinformation andinstructions:ListList pertinentpertinent healthhealth oror medicalmedical informationinformation andand instructions:instructions:ImmunizationRecords Providedes NoImmunizationProvided NoImmunization RecordsRecordsProvided YesYes No Carolina law, parents/guardian must present certification of immunizations on the firstImmunizationRecordsProvided Yes NoIfIf d Yes unization RecordsProvided Yes No CarolinaIf no,no, inindaycompliancewithNorthCarolina law,law, parents/guardianparents/guardianmust presentpresentcertificationof immunizationsimmunizationson thethe thefirstofschoolentry.IfIf sIf no, anmustpresentcertificationofimmunizationsonthe endarto schoolprovideentry.documentationor the studentshall be excludedschooluntil proofday ofofschoolentry.If documentationdocumentationis notnot presented,presented,parents fromand/orguardianshave is30presented.calendar xcludedfromschooluntilproofispresented.toto provideprovide documentationdocumentation oror thethe studentstudent shallshall bebe excludedexcluded fromfrom schoolschool untiluntil proofproof isis needsitwhengivingPermission for school/nurse to share my child’s shot records with a healthcare provider who needs it when giving mymy childchild rsetosharemychild’sshotrecordswithaa izations. Yes childimmunizations. Yes ychildimmunizations. YesYes NoNo Yes No Yes dicatethestudent’scurrentacademic indicatethestudent’scurrentPlease indicate the student’s current academicacademic placementplacementPlease indicate the student’s current academic placementPleaseindicatethecurrentplacement NewKindergartenerfor theschoolyear New studententering gradefortheschool yearPleaseindicatethe student’sstudent’scurrent academicacademicplacement NewNew KindergartenerKindergartener forfor thetheschoolschool yearyear NewNew studentstudent enteringentering gradegradeforfor thetheschoolschool yearyear NewKindergartenerfortheschoolyear Newstudententeringgradefortheschoolyear NewKindergartenerfortheschoolyear Newstudententeringgradeforthe NewPre-Kindergartener,pleaseselectprogram: MontessoriPre-K/BrightBeginnings ECKindergartenerfor theschoolyear NewNCstudententeringgradeforthe schoolschool yearyear NewPre-Kindergartener,pleaseselectprogram: Montessori NCPre-K/BrightBeginnings EC NewPre-Kindergartener,pleaseselectprogram: Montessori NCPre-K/BrightBeginnings EC NewPre-Kindergartener,pleaseselectprogram: Montessori NCPre-K/BrightBeginnings EC NewPre-Kindergartener,pleaseselectprogram: Montessori NCPre-K/BrightBeginnings EC New Pre-Kindergartener, please select program: Montessori NC Pre-K/Bright Beginnings ECPleasePlease indicateindicate thethe student’sstudent’s previousprevious academicacademic placementplacement ent ent Charterschool:in outsideCountyPleaseindicatethe student’spreviousCountyacademicplacement Charterschool: in MecklenburgMecklenburgCounty outside MecklenburgMecklenburgCounty Charterschool: inMecklenburgCounty outsideMecklenburgCounty Charterschool: inMecklenburgCounty outsideMecklenburgCounty school: inMecklenburgCounty outsideMecklenburgCounty PrivateCharterschool:Privateschool: inMecklenburgCounty outsideMecklenburg PrivatePrivate school:school: inin MecklenburgMecklenburg CountyCounty outsideoutside MecklenburgMecklenburg CountyCounty County Privateschool: inMecklenburgCounty outsideMecklenburgCounty school(otherthanCharter): inMecklenburgCounty outsideMecklenburgCounty PublicPrivateschool: inMecklenburgCounty outsideMecklenburgCounty Publicschool(otherthanCharter): inMecklenburgCounty outsideMecklenburg PublicPublic schoolschool (other(other thanthan Charter):Charter): inin MecklenburgMecklenburg CountyCounty outsideoutside MecklenburgMecklenburg CountyCounty County GroupPublicschool(otherthanCharter): inMecklenburgCounty outsideMecklenburgCounty homeorotherinstitution RegisteredHomeSchool Other Public school(otherCharter): in MecklenburgCountyHome Schooloutside MecklenburgCounty Grouphome orotherthaninstitution Registered Other Grouphomeorotherinstitution RegisteredHomeSchool Other Grouphomeorotherinstitution RegisteredHomeSchool Other LicensedChildcare HeadStart NCPre-K/BrightBeginnings PreschoolGrouphomeorotherinstitution RegisteredHomeSchool Other Preschool LicensedChildcareHeadStart NCPre-K/BrightBeginnings PreschoolPreschool LicensedLicensed ChildcareChildcare HeadHead StartStart NCNC Pre-K/BrightPre-K/Bright BeginningsBeginnings Preschool LicensedChildcare HeadStart NCPre-K/BrightBeginnings - this isthe student’sfirstChildcareacademic placement Start NonePreschoolLicensed Head NC Pre-K/Bright Beginnings NoneNone --- thisthis isis thethe student’sstudent’s firstfirst academicacademic placementplacement Nonethisisthestudent’sfirstacademicplacement Nonethisisthestudent’sfirstacademicplacement SchoolNone - Attendedthis is the student’s first academic placement choolAttendedLastSchoolLast School eStateStateStateStateZipZip CodeCodeZipCodeZipZip CodeCodeDatePreviousDate lastlast attendedattendedPrevious StudentStudent IDID tschoolattendedMonthYearHasthe student ever been enrolledin CMS? If yes, last school S? Ifyes,last ,schoolHasthestudenteverbeenenrolledin CMS?CMS? SchoolIfyes, lastlastschool attendedattended Yes NoName Yes NoSchoolName Yes NoSchoolName Yes NoSchoolName YesSchool NoOnlySchool WheredidthestudentattendMiddle/JuniorHigh?High WheredidthestudentattendMiddle/JuniorWhere did the student attend Middle/Junior High?High?SchoolSchool YearYearSchoolYearSchoolSchool YearYearEvery Child. CityEveryDay. For a Better ameNameNameHasyour studentgraduatedfrom highschool?HasgraduatedHas youryour studentgraduated fromfrom highhigh l?HasyourstudentgraduatedfromhighHas your student graduated from high school?school?RevisedRevised 7/20147/2014Revised 7/2014Revised 7/2014 Yes YesYes Yes YesYesAddressAddressAddressAddress No NoNo No NoNoCityCityCityCityStateStateStateState

Page 5 of 6CHARLOTTE-MECKLENBURG SCHOOLSForm 725110.1STUDENT ENROLLMENT FORM7/2014Does your child have an Individualized Education Program (IEP)? Yes NoDoes your child have an Individualized Education Program (IEP)? IEP)?Yes NoYes NoFederal and state polices require schools to determineterminethe language(s)the language(s)spokenspokenat homeat homeby eachby eachstudent.student.If theIfanswerthe answerto anytoofanytheofquestionsthe questionsbelowbelowisDoes your child have a 504 Educational Plan? ay Yes Noassessedbe assessedon theonNoWIDAthe WIDAACCESSACCESSPlacementPlacementTest (W-APT)Test (W-APT)to determineto .proficiency.Does yourDoeschildyourhavechilda 504haveEducationala 504 EducationalPlan? Plan?Yes NoYes dHomeon the results,your Surveychild may be identified asfiedLimitedas )and qualifyand qualifyfor Englishfor EnglishLanguageLanguageLearnerLearner(ELL) ate denotincludePre-K)Pre-K)Federal and state polices require schools to determine the language(s) spoken at home by each student. If the answer to any of the questions below cesschoolsrequiretoschoolsdetermineto pokenhomeatbyhomeeachstudent.each student.If theanswerIf theEnglishtoanswerany oftotheanyquestionsofproficiency.the questionsbelow isbelow isa languageotherthanEnglish,yourchild maybe assessedtheACCESSatPlacementTest eproficiency.proficiency.on the results, your child may be identified as Limited English Proficient (LEP) and qualify for English Language Learner (ELL) astousecommunicate?to communicate?BasedonBasedtheresults,ondoesthe yourresults,childyourmaychildbeidentifiedmaybe identifiedas LimitedEnglishLimitedProficientEnglish Proficient(LEP) and(LEP)qualifyandforqualifyEnglishfor LanguageEnglish LanguageLearner Learner(ELL) services.(ELL) services.Date your child first attended K-12 school in the U.S. (do not include Pre-K)Date yourDatechildyourfirstchildattendedfirst attendedK-12 schoolK-12ins

PROCEDURES FOR ENROLLMENT. 12/2017 Form 725110.1. Page 1 of 6 . 7/2014. . For more information visit www.cms.k12.nc.us, email [email protected] or call 980-343 -533 5. For Proof of Residency. ONE (1) of the following documents must be shown: most Copy of residential lease