Westby Area School District
Student Enrollment Packet

What should I bring to enroll my child?

Column A

Column B

Documents must be issued within the last 30 days or five (5) days after enrollment.

  • Mortgage statement or property deed.
  • Most current Property Tax statement.
  • A closing statement for purchase of home.
  • A signed lease including the Landlord's name, address, and telephone number (Will be verified)
  • Current utility bill (e.g., gas, water/sewer, electric)
  • Utility deposit receipt for new service.
  • Department of Health and Human Resources document for benefits.
  • Auto insurance or health insurance
  • statement.
  • Homeowner’s or Renter’s Insurance statement.
  • Certified copy or filed petition for guardianship (if pending) and final decree when granted.
  • Notarized Residency Verification Form and/or personal visit by designated School District Official

If you have these documents, it helps to bring them too:

                       New Student Enrollment/ Emergency Form     2018/19

                 *Required Fields   (Information Verified by Birth Certificate @ time of registration)      Intake official, Initial Here: _________

*Last Name: _________________________________ *First Name: ______________________________ *Full Middle Name: ________________

         (Please use legal name EXACTLY as it appears on birth certificate)       Suffix:  ________ (if it appears on birth certificate)

              “Other” Last Name_______________________________ “Other” First Name ________________________________

                                                     

*Birth Date _________   *Gender:  Male /Female     *Place of Birth: _________________  ______   ______________    *Grade: ______

                                                               (Circle One)                                                        City  /       State  /            County                                                                 

*Hispanic/Non-Hispanic    *Federal Race:   Am. Indian/ Native Alaskan      Asian     African American/Black    Native Hawaiian/ Pacific Islander   White    

                   (Circle one)                                                                                                                                  (Circle all that apply)             

                                                                                                        

                * Born in the United States of America:    Yes/No              If “No” *Country of Birth____________________________

                                    *Language:  English/Spanish/Other________________________  Special Education:  Yes/No 

                                                                                    (Circle One)                                                                                                                                                               (Circle)                                                                                                                                                                                                                    

Race/Ethnicity Verification  (Circle one)   Not Verified        Verified by Staff        Verified by Student Family       Date of Verification: ________________

*Westby District Resident: Yes/No    ___________________________           *SS# ______-____-_______             Full Time/Part Time 

                                                                    (Name of Resident District)                                                                                (Circle One)

                                                  Residency verified with current utility/tax bill. Intake official, initial here: _______

 

Resides with:  Dad/Mom/Both/Other__________         

__________________________________________________________________________________

                                                                                            Family Information

*First Guardian:

*Last Name: _________________________________________  *First Name: ___________________________  Gender:  M/F

*Relationship:  Dad/Mom/Other (specify): _________________________              * E-Mail:____________________________________________

*Home Phone: _______________________        Work Phone: _____________________       Cell Phone: _________________________

*Address: (Required Information) ___________________________________________________________________________________

                                                             Street/Rd                                                  City                                   State                 Zip Code

*PO Box____________      Occupation:______________________________________ Employer:_________________________________

*Second Guardian:  (If different household, should they receive school correspondence?)  Yes ___   No__­_

*Last Name: _________________________________________   *First Name: ____________________________   Gender:  M/F

*Relationship:  Dad/Mom/Other (specify): _________________________       *E-Mail: ___________________________________________

*Home Phone: ______________________          Work Phone: ____________________             Cell Phone: _______________________

*Address: (Required Information)   __________________________________________________________________________________

                                                                    Street/Rd                                          City                                   State                    Zip Code

*PO Box: ____________   Occupation:  _______________________________________ Employer: _______________________________

__________________________________________________________________________

                                                                              * Emergency Contact and Alert Information

Last Name: _____________________________________             First Name/s: _____________________________________________

Address: ________________________________________________________ Relationship: ______________________________

Home Phone: ___________________________ Work Phone: ________________________ Cell Phone: __________________________

         *Parent/Guardian Signature:_________________________________________________________  *Date:___________________________

Request for Student Records

School Transferring from:______________________________________________

Address___________________________________________________________

                        Street                                       City                                             State                            Zip Code

 

Please circle any of the services that your child was or may have received:

                            TITLE                                            SPEECH                                                PHYSICAL THERAPY

LEARNING DISABILITIES               SCHOOL SOCIAL WORKER          SCHOOL PSYCHOLOGIST

OTHER_________________________________________________________________________________

 

(FOR OFFICE USE ONLY)

 

Date:                                                                        _____________

Email entry@westby-norse.org                                 _____________

Fees Paid:                                                                _____________

Class List                                                                 _____________

Bus                                                                          _____________

Census Card                                                            _____________

Report Card                                                            _____________

Student Directory                                                    _____________

Notice to Teachers                                           _____________

Request for Records                                        _____________

Records to Teacher                                          _____________

Information to Lisa Olson for Skyward/WSLS/ISES        _____________