Verification Of Student Admission Information (For Student Residing With Parent Or Guardian)/proof Of Residency Form Page 7

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General Information Survey
(School Enrollment Form for Foster Care Student)
Student Name________________________________________________________________________________
DOB________________
Age:________
Grade:____________
Campus:_________
Previous School Enrolled at_______________________________________________________
1. Has your child ever attended an ROISD school?
Yes____ No_____
If YES, name of ROISD school________________________________________
2. Has your child received the following services:
 Bilingual program
Yes_____
No____
 ESL program
Yes_____
No____
 Special Education
Yes_____
No____
A. Resources
B. Speech Therapy C. Other________
 504 Services
Yes ____ No____
 Dyslexia
Yes____
No____
 Intervention Assistance Team
Yes_____ No_____
 Gifted and Talented Classes
Yes_____ No_____
 Social Services
Yes_____ No_____
i.
2085 Form
Yes_____
No___
If yes, please specify the type:
___________________________________________
 Health Care Services
Yes_____
No_____
 Counseling
Yes_____
No_____
 Retained
Yes_____
No_____
If Yes, what grade? _____________
 Other Services (please specify)___________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Parent/Guardian Signature_______________________________________________Date____________________
Please send form to Donna Knight, Coordinator of Student and Family Services. If you
have any questions please call her @ 972 617-4658.

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