Wellington-Napoleon r-ix enrollment Packet Student Enrollment Checklist

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Wellington-Napoleon R-IX Enrollment Packet

Student Enrollment Checklist

Enrollment Date ___________________________________ Requested Start Date ____________________________

Student Full Name _____________________________________________________ Grade _____________________
Legal Custodial Parent/Guardian _________________________________________ Phone ____________________


___Consent for Release of Information

___Wellington-Napoleon R-IX Enrollment Form

___Basis for Admission of Student

___Proof of Residency within the R-IX School District Boundaries

___Safe Schools Act Statement

___Medical History Forms

___Current Immunization Records

___Proof of age- Official document that states student’s legal name, date of birth, and name of parent(s)

(If the student is not living with at least one of the parents listed on the official document, you will need to provide proof of court appointed guardianship)

Residency can be proven by submitting one of the documents described below:

  1. A current, original utility bill (only electricity, gas, water, or water statement or account) that means the following:

  2. Rental/Lease agreement including:

  3. A contract to build to purchase a home in the district reflecting a possession or closing date within 90 calendar days of the first day of attendance.

_____ Interested in Sports Activities Y _____ N _____

_____ Interested in a Free/Reduce Lunch Form Y______ N ______

Office Use Only:
____ Academic Records (const. test records) Date Received _________ Counselor: _______________

____ Withdrawal Grades Date Received _________ Secretary: _______________

____ Disciplinary Records Date Received _________ Secretary: _______________

____ Test Scores Date Received _________ Special Programs: _________

____ Health Records Date Received _________ Nurse: __________________

____ Attendance Records Date Received _________ Secretary: _______________

____ Student Identification Records Date Received _________ Secretary: _______________

____ Special Education Records Date Received _________ Special Programs: _________

____________________________________ Completed Enrollment Packet---Principal

(School Letterhead)

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