08/11/14 07/13/15 SCHOOL ADMISSIONS - fcps1.orgportfolio.fcps1.org/policy/Section 7/7-2.3.pdf · Special Power of Attorney ... When the parents of such person are dead and the person

FAUQUIER COUNTY PUBLIC SCHOOLS Policy: 7-2.3

Adopted: 04/10/12

Revised: 02/10/14, 08/11/14, 07/13/15

SCHOOL ADMISSIONS

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1. Persons to Whom an Education in the Fauquier County Public Schools Shall be Free

1.1. Consistent with Article VIII, Section 1 of the Constitution of Virginia, no person may be charged tuition for

admission or enrollment in Fauquier County Public Schools, whether on a full-time or part-time basis, who

meets the residency criteria set forth in Virginia Code Section§ 22.1-3 and under “Reside” below.

1.2. No person of school age shall be charged tuition for enrollment in a general education development or

alternative program offered as a regional or division-wide initiative by the local school division in which such

person is deemed to reside pursuant to Virginia Code Section§ 22.1-3 and under “Reside” below.

2. Definitions

2.1. “Bona Fide Resident (Resident)” - An individual shall be deemed a bona fide resident of the Fauquier County

School Division when he or she has a physical residency in the County with the intent to make it a fixed and

permanent home and is not residing in the County solely for the purpose of obtaining school privileges.

Further, any change in residence must be bona fide and at a minimum the following conditions must exist:

2.1.1. The original residence must be abandoned by the entire family

2.1.2. The entire family must abandon the residence and take with them the household goods

2.1.3. The change in residence must be made with the intent that it is permanent

Before making a determination that an individual is not a bona fide resident of the Fauquier County School

Division, the superintendent or his/her designee shall provide such person with notice and an opportunity to

present all related evidence in support of his or her establishment of bona fide residence.

The superintendent or his/her designee may refuse free admission of any individual to a public school of the

Fauquier County School division unless he/she determines that the individual is a resident or is otherwise

qualified to attend in accordance with this policy.

2.2. “Non-Resident” - A non-resident pupil is one who is not a resident student of the Fauquier County School

Division in accordance with the terms of this policy, but who attends or proposes to attend a Fauquier County

Public School.

2.3. “Displaced Fauquier Resident” - An individual who becomes a non-resident during the school year. The

superintendent may permit attendance tuition-free for the remainder of the semester or term for students who

become non-residents during that term or semester.

2.4. “Future Fauquier Resident” - An individual who will become a resident during the school year. The

superintendent may permit attendance tuition-free for students who will become residents of Fauquier County

during the semester or term during which they will physically become residents. Proof of future residency (e.g.

housing contract, rental agreement, etc.) is required.

See Policy 7-4.2 for information regarding athletic eligibility residency requirements.

3. Reside

3.1 A person of school age (i.e., a person who will have reached his fifth birthday on or before September 30 of the

school year and who has not reached 20 years of age on before August 1 of the school year) is eligible for

admission on a non-tuition basis if residing in the Fauquier County School Division, or if eligible for admission

http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+22.1-3



Adopted: 04/10/12

Revised: 02/10/14, 08/11/14, 07/13/15

SCHOOL ADMISSIONS

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as a homeless person pursuant to this policy. School officials may not inquire into the student’s citizenship or

visa status in determining eligibility for tuition-free enrollment in Fauquier County Public Schools. A person

with a disability who has reached the age of two (2) years on or before September 30 th of the school year and

who has not reached the age of twenty-two (22) years and who has been determined to be eligible for a program

of special education is considered to be of school age and eligible to attend Fauquier County Public Schools.

3.2. A person of school age shall be deemed to reside in the school division:

3.2.1. When the person is living with a natural parent, a parent by legal adoption, or a legal guardian as

determined by court documentation, in the Fauquier County School Division. The student is presumed

to be a resident student, even if the parent is not the custodial parent under a property settlement

agreement or divorce decree;

3.2.2. No person of school age shall be denied admission or charged tuition when (i) such person's custodial

parent has been deployed outside the United States as a member of the Virginia National Guard or as a

member of the United States Armed Forces; and (ii) such person's custodial parent has executed a

Special Power of Attorney under Title 10, United States Code, § 1044b providing for the care of the

person of school age by an individual who is defined as a parent in Virginia Code Section § 22.1-1

during the time of his deployment outside the United States. The person of school age shall be allowed

to attend a school in the school division in which the individual providing for his care, pursuant to the

Special Power of Attorney under Title 10, United States Code, § 1044b, resides. Furthermore, when

practicable, such persons of school age may continue to attend school in the Virginia school division

they attended immediately prior to the deployment and shall not be charged tuition for attending such

division;

3.3. When the parents of such person are dead and the person is living with a person in loco parentis who actually

resides within the school division;

3.4. When the parents of such person are unable to care for the person and the person is living, not solely for school

purposes, with another person who resides in the school division and is (i) the court-appointed guardian, or has

legal custody, of the person (ii) acting in loco parentis pursuant to placement of the person for adoption by a

person or entity authorized to do so under § 63.2-1200; or (iii) an adult relative providing temporary kinship

care as that term is defined in §63.2-100. The school division will require one or both parents and the relative

providing kinship care to submit signed, notarized affidavits (a) explaining why the parents are unable to care

for the person, (b) detailing the kinship care arrangement, and (c) agreeing that the kinship care provider or the

parent will notify the school within 30 days of when the kinship care arrangement ends, as well as a power of

attorney authorizing the adult relative to make educational decisions regarding the person. The school division

will require the parent or adult relative to obtain written verification from the department of social services

where the parent or parents live, or from both that department and the department of social services where the

kinship provider lives, that the kinship arrangement serves a legitimate purpose that is in the best interest of the

person other than school enrollment. If the kinship care arrangement lasts more than one year, a school division

will require continued verification directly from one or both departments of social services as to why the parents

are unable to care for the person and that the kinship care arrangement serves a legitimate purpose other than

school enrollment.

3.5. When the person is living with a parent, guardian, or person in loco parentis in a temporary shelter in the school

division, not solely for school purposes;

3.6. When the person is living in the school division not solely for school purposes, as an emancipated minor; or




Adopted: 04/10/12

Revised: 02/10/14, 08/11/14, 07/13/15

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3.7. When the person has been placed in a foster care placement within the school division by a local social services

agency, upon joint determination of the placing social services agency and the school division that such

attendance is in the best interest of the child. No person of school age who is the subject of a foster care

placement will be charged tuition regardless of whether the child is attending the school in which she or he was

enrolled prior to the most recent foster care placement or is attending a school in the receiving school division.

3.8. Any individual who resides within the School Division and is beyond school age (who has reached his/her 20th

birthday on or before August 1 of the school year) may, at the discretion of the School Board, be admitted into

Fauquier County Public Schools. Such individuals may be charged tuition at the discretion of the School Board.

3.9. Certain other students may be admitted into the public schools of the division and may be charged tuition in

accordance with section 22.1-5 of the Code of Virginia and pursuant to Fauquier County School Board

regulations.

3.10. No child of a person on active military duty attending a school free of charge in accordance with this policy

shall be charged tuition by the school division upon such child's relocation to military housing located in

another school division in the Commonwealth, pursuant to orders received by such child's parent to relocate to

base housing and forfeit his military housing allowance. Such children shall be allowed to continue attending

school in the school division and shall not be charged tuition for attending such school. Such children shall be

counted in the average daily membership of the school division in which they are enrolled. Further, the school

division in which such children are enrolled subsequent to their relocation to base housing shall not be

responsible for providing for their transportation to and from school.

3.11. Parents or guardians must show proof of residency at the time of enrollment or at any time there is a change in

residence. A combination of at least two forms of proof of residency must be provided. Examples of acceptable

documents include a housing contract, rental agreement, property tax bill, utility bill and a homeowners or

renters insurance policy. If the family is not designated as homeless and is living at a residence and cannot

provide a lease or rental agreement, (for example if the family is living with a relative or friend or on the

property of an employer), a notarized statement from the resident that the family is residing in the home plus the

“resident’s” proof of residency is required. If the family cannot show proof of residency, then they will be

required to complete the Request for Out-of-County Tuition Status Form and pay tuition until such time proof

of residency can be shown.

3.12. Parents or guardians may be required to provide additional verification of residency at the request of the

division superintendent or designee if the superintendent has reason to question the validity of a family’s

residency documentation.

4. Additional Admission Requirements

4.1. A Student Data Form must be completed for enrollment.

4.2. An enrolling pupil must be accompanied by the person with whom he/she lives, unless such individual is an

emancipated minor; either a natural parent, or a court-appointed legal guardian or legal custodian, or a person

acting in loco parentis. The accompanying adult will be required to present verification of identity with official

photo identification.

4.3. An individual other than a pupil’s natural parent will be required to provide official proof of custody or

guardianship, unless such individual is temporarily acting in loco parentis pursuant to § 22.1-3. Acceptable

proof of custody is a certified copy of an Order of custody or guardianship issued by a Virginia court, or by

another state or country, or a copy of a special power of attorney.


Adopted: 04/10/12

Revised: 02/10/14, 08/11/14, 07/13/15

SCHOOL ADMISSIONS

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4.4. Except as otherwise provided below, no pupil shall be admitted for the first time to any public school in any

school division in Virginia unless the person enrolling the pupil presents, upon admission, a certified copy of

the pupil's birth record. The principal or his designee shall record the official state birth number from the pupil's

birth record into the pupil's permanent school record and may retain a copy in the pupil's permanent school

record. If a certified copy of the pupil's birth record cannot be obtained, the person so enrolling the pupil shall

submit an affidavit setting forth the pupil's

4.5. age and explaining the inability to present a certified copy of the birth record. If the school division cannot

ascertain a child's age because of the lack of a birth certificate, the child shall nonetheless be admitted into the

public schools if the division superintendent determines that the person submitting the affidavit presents

information sufficient to estimate with reasonable certainty the age of such child.

4.6. If a certified copy of the birth record is not provided, the administration shall immediately notify the local law

enforcement agency. The notice to the local law-enforcement agency shall include copies of the submitted proof

of the pupil's identity and age and the affidavit explaining the inability to produce a certified copy of the birth

record.

4.7. Within 14 days after enrolling a transfer student, the administration shall request documentation that a certified

copy of the pupil's birth record was presented when the pupil was enrolled in the former school.

4.8. The Department of Education shall develop a system of unique student identification numbers. The School

Board shall assign such a number to each student enrolled in a public elementary school or secondary school.

No student identification number shall include or be derived from the student’s federal social security number.

Each student shall retain his student identification number for as long as he is enrolled in a public elementary or

secondary school in the Commonwealth.

4.9. Tuition rates are established each year in accordance with the provisions of § 22.1-5 of the Code of Virginia.

4.10. Prior to admission to the Fauquier County Public School Division, the parent, guardian, or other person having

control or charge of the child shall provide, upon registration,

4.11. a sworn statement or affirmation, indicating whether the student has been expelled from school attendance at a

private school or in a public school division of the Commonwealth or another state for an offense in violation of

school board policies relating to weapons, alcohol or drugs, or for the willful infliction of injury to another

person. This document shall be maintained as a part of the student’s scholastic record; and

4.12. a sworn statement or affirmation indicating whether the student has been found guilty of or adjudicated

delinquent for any offense listed in subsection G of Va. Code § 16.1-260 or any substantially similar offense

under the laws of any state, the District of Columbia, or the United States or its territories. This document shall

be maintained by the superintendent and by any others to whom he disseminates it, separately from all other

records concerning the student. However, if the school administrators or the school board takes disciplinary

action against a student based upon an incident which formed the basis for the adjudication of delinquency or

conviction for an offense listed in subsection G of § 16.1-260, the notice shall become a part of the student's

disciplinary record.

4.13. When the child is registered as a result of a foster care placement, the information required under this

subsection must be furnished by the local social services agency or licensed child-placing agency that made the

placement.

4.14. A student, who has been expelled or suspended for more than thirty days from attendance at school by a school

board or a private school in Virginia or in another state or for whom admission has been withdrawn by a private



Adopted: 04/10/12

Revised: 02/10/14, 08/11/14, 07/13/15

SCHOOL ADMISSIONS

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school in Virginia or another state may be excluded from attendance in the Fauquier County School Division

regardless of whether such student has been admitted to another school division or private school in Virginia or

in another state subsequent to such expulsion, suspension, or withdrawal of admission upon a finding that the

student presents a danger to the other students or staff of the school division after (i) written notice to the

student and his/her parent that the student may be subject to exclusion, including the reasons therefore, and

notice of the opportunity for the student or his parent to participate in a hearing to be conducted by the

superintendent or his designee regarding such exclusion; and (ii) a hearing of the case has been conducted by

the superintendent or his/her designee; and the decision has been to exclude the student from attendance. The

student or his parent may file a written petition for review with the School Board within 15 days of notice of the

decision of the superintendent or his/her designee. If the School Board grants a review of the record, the

decision of the superintendent or his/her designee may be altered.

Upon the expiration of the exclusion period for an expulsion or a withdrawal of admission, which period shall

be established by the School Board, committee thereof, or superintendent or his designee, as the case may be, at

the relevant hearing, the student may petition the School Board for readmission. If the petition for readmission

is rejected, the School Board shall identify the length of the continuing exclusion period and the subsequent date

upon which such student may petition the School Board for readmission.

For the purposes of this section, the division superintendent’s designee shall be the Assistant Superintendent for

Student and Special Education Services or a professional employee within the administrative offices of the

school division who reports directly to the division superintendent and who is not a school-based instructional

or administrative employee.

In excluding any such expelled student from school attendance, the School Board may accept or reject any or all

of any conditions for readmission imposed upon such student by the expelling school board pursuant to Va.

Code § 22.1-277.06. The excluding School Board shall not impose additional conditions for readmission to

school.

4.15. This policy does not preclude contractual arrangements between the Fauquier County School Board and

agencies of the federal government or the school board of another jurisdiction to permit students not otherwise

eligible to attend Fauquier County Public Schools.

4.16. Prior to admission, the student must document compliance with, or eligibility for exemption from, the physical

examination and immunization requirements contained in §§ 22.1-270, 22.1-271.2 and 32.1-46 of the Code of

Virginia and regulations 7-2.3(B) and 7-2.3(C).

4.17. If the person enrolling a child who has been placed in foster care by a local social services agency is unable to

produce a report of a comprehensive physical examination and/or proof of immunization, the student shall be

immediately enrolled; however, the person enrolling the child shall provide a written statement that, to the best

of his knowledge, the student is in good health and is free from communicable or contagious disease. In

addition, the placing social service agency shall obtain and produce the required documents or otherwise ensure

compliance with the statutory requirements for the foster child within 30 days after the child’s enrollment.

5. Admission of Homeless Children

5.1. The Fauquier County School Board is committed to educating homeless children and youth. The division

superintendent or his designee shall develop guidelines for contacting shelter agencies, ministerial associations,

and other community service providers to identify homeless children within the school division. Such children

shall be provided with educational services, including specialized services to meet their needs, as determined

and directed by the division superintendent or his designee and in accordance with state and federal law.


Adopted: 04/10/12

Revised: 02/10/14, 08/11/14, 07/13/15

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5.2. Requirements

5.2.1. The school division will serve each homeless student according to the student’s best interest and will:

5.2.1.1. continue the student’s education in the school of origin for

5.2.1.1.1. the duration of homelessness; and

5.2.1.1.2. a student who becomes homeless between academic years or during an

academic year, or for the remainder of the academic year if the student

becomes permanently housed during an academic year; or

5.2.1.2. enroll the student in any public school that non-homeless students who live in the

attendance area in which the student is actually living are eligible to attend.

5.2.2. In determining what is in the best interest of a homeless student, the School Board shall:

5.2.2.1. to the extent feasible, keep the student in the school of origin, except when doing so is

contrary to the wishes of the student’s parent or guardian;

5.2.2.2. provide a written explanation, including a statement regarding the right to appeal as

described below, to the homeless student’s parent or guardian, if the school division sends

the student to a school other than the school of origin or a school requested by the parent or

guardian; and

5.2.2.3. in the case of an unaccompanied youth, ensure that the school division’s homeless liaison

assists in placement or enrollment decisions regarding the student, considers the views of

such unaccompanied youth, and provides notice to such youth of the right to appeal,

described below.

5.3. Enrollment

5.3.1. The school selected in accordance with this regulation shall immediately enroll the homeless student,

even if the student is unable to produce records normally required for enrollment, such as previous

academic records, birth records, medical records, proof of residency, or other documentation.

5.3.2. The enrolling school shall immediately contact the school last attended by the student to obtain

relevant academic and other records.

5.3.3. If the student needs to obtain immunizations, or immunization, birth, or medical records, the enrolling

school shall immediately refer the parent or guardian of the student to the school division’s homeless

liaison, who shall assist in obtaining necessary immunizations, or immunization, birth, or medical

records.

5.3.4. If the documentation regarding the comprehensive physical examination required for admission cannot

be furnished for a homeless child or youth, and the person seeking to enroll the pupil furnishes to the

school division an affidavit stating that the documentation cannot be provided because of the

homelessness of the child or youth and also indicating that, to the best of his or her knowledge, such

pupil is in good health and free from communicable or contagious disease, the school division shall

immediately refer the student to the local school division homeless liaison who shall, as soon as


Adopted: 04/10/12

Revised: 02/10/14, 08/11/14, 07/13/15

SCHOOL ADMISSIONS

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practicable, assist in obtaining the necessary physical examination by the local health department or

other clinic or physician’s office and shall immediately admit the pupil to school.

5.3.5. The decision regarding placement shall be made regardless of whether the student lives with the

homeless parents or has been temporarily placed elsewhere.

5.4. Enrollment Disputes

5.4.1. If a dispute arises over school selection or enrollment in a school:

5.4.1.1. the homeless student shall be immediately admitted to the school in which enrollment is

sought and provided all services for which he or she is eligible, pending resolution of the

dispute;

5.4.1.2. the parent or guardian of the student shall be provided with a written explanation of the

school’s decision regarding school selection or enrollment, including the rights of the

parent, guardian or student to appeal the decision;

5.4.1.3. the student, parent or guardian shall be referred to the school division’s homeless liaison

who shall carry out the appeal process as expeditiously as possible after receiving notice of

the dispute; and

5.4.1.4. in the case of an unaccompanied youth, the homeless liaison shall ensure that the youth is

immediately enrolled in school pending resolution of the dispute.

5.5. Appeal Process

5.5.1. Oral Complaint - In the event that an unaccompanied student or the parent or guardian of a student

(hereinafter referred to as the Complainant) disagrees with a school’s decision regarding the student’s

eligibility to attend the school, the Complainant shall orally present his position to the school division’s

homeless liaison.

5.5.2. Written Complaint - If the disagreement is not resolved within five (5) school days, the Complainant

may present a written complaint to the homeless liaison. The written complaint must include the

following information: (i) the date the complaint is given to the homeless liaison; (ii) a summary of

the events surrounding the dispute; (iii) the name(s) of the school division personnel involved in the

enrollment decision; and (iv) the result of the oral complaint to the homeless liaison.

5.5.2.1. Within five (5) school days after receiving the written complaint, the homeless liaison will

reach a decision regarding the contested enrollment and shall provide a written statement of

that decision, including the reasons therefore, to the Complainant. The liaison will inform

the division superintendent of the formal complaint and its resolution.

5.5.3. Appeal to Division Superintendent - If the Complainant is not satisfied with the written decision of the

homeless liaison, the Complainant may appeal that decision to the division superintendent by filing a

written appeal. The homeless liaison shall ensure that the division superintendent receives copies of

the written complaint and the response thereto. The division superintendent or his designee shall

schedule a conference with the Complainant to discuss the complaint. Within five (5) school days of

receiving the written appeal, the division superintendent, or his designee, shall provide a written

decision to the Complainant, including a statement of the reasons therefore.


Adopted: 04/10/12

Revised: 02/10/14, 08/11/14, 07/13/15

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5.5.4. Appeal to the State - If the Complainant is not satisfied with the written decision of the Superintendent,

the Complainant may appeal that decision within ten (10) business days from receipt of the written

notice to the local homeless education liaison who will present the appeal to the Office of the State

Coordinator of Homeless Education (Project HOPE-Virginia). The local homeless education liaison

will maintain a file of written notification given to parents, guardians, or unaccompanied youth. The

liaison will clarify the state-level decision making process. The State Coordinator or designee shall:

5.5.4.1. Review local School Division records to ensure proper procedures were followed and,

based on the review of School Division records and consultation with Project HOPE-

Virginia Advisory Board members, when appropriate, forward a recommendation to the

Superintendent of Public Instruction regarding the appropriate placement for the student

within five (5) work days of receiving the appeal.

5.5.4.2. The Assistant Superintendent of Special Education and Student Services, or designee, will

make the final determination. The family or unaccompanied youth, the local School

Division(s), the Director of Student Services, and Project HOPE-Virginia will be informed

by the State Superintendent of Public Instruction of the final disposition within ten (10)

business days of receiving the case and recommendation from the State Coordinator for

Homeless Education.

5.5.4.3. Project HOPE-Virginia staff will provide technical assistance to the School Division, as

needed, to comply with final determination.

5.5.4.4. Project Hope-Virginia staff will follow-up with the School Division thirty (30) business

days after the final disposition by the Assistant Superintendent of Special Education and

Student Services to determine the status of the child or youth’s enrollment.

5.6. Comparable Services

5.6.1. Each homeless student shall be provided services comparable to services offered to other students in

the school attended by the homeless student, including the following:

5.6.1.1. transportation services;

5.6.1.2. educational services for which the student meets the eligibility criteria, such as services

provided under Title I, educational programs for children with disabilities, and educational

programs for students with limited English proficiency;

5.6.1.3. programs in vocational and technical education;

5.6.1.4. programs for gifted and talented students; and

5.6.1.5. school nutrition programs.

5.7. Transportation

5.7.1. At the request of the parent or guardian (or in the case of an unaccompanied youth, the homeless

liaison), transportation will be provided for a homeless student to and from the school of origin as

follows:


Adopted: 04/10/12

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SCHOOL ADMISSIONS

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5.7.1.1 If the homeless child or youth continues to live in the area served by the school division in

which the school of origin is located, the child’s or youth’s transportation to and from the

school of origin shall be provided or arranged by the school division in which the school of

origin is located.

5.7.1.2. If the homeless child’s or youth’s living arrangements in the area served by the school

division in which the school of origin is located terminate and the child or youth, though

continuing his or her education in the school of origin, begins living in an area served by

another school division, the school division of origin and the school division in which the

homeless child or youth is living shall agree upon a method to apportion the responsibility

and costs for providing the child with transportation to and from the school of origin. If the

school divisions are unable to agree upon such method, the responsibility and costs for

transportation shall be shared equally.

5.8. Definitions

5.8.1. The terms “homeless student,” “homeless child,” and “homeless youth” mean an individual who

lacks a fixed, regular, and adequate nighttime residence, and include:

5.8.1.1. children and youth, including unaccompanied youth who are not in the physical custody of

their parents, who

5.8.1.1.1. are sharing the housing of other persons due to loss of housing, economic

hardship, or other causes; are living in motels, hotels, trailer parks, or

camping grounds due to the lack of alternative adequate accommodations or

in emergency, congregate, temporary or transitional shelters; are abandoned

in hospitals; or are awaiting foster care placement;

5.8.1.1.2. have a primary nighttime residence that is a public or private place not

designed for or ordinarily used as a regular sleeping accommodation for

human beings; or

5.8.1.1.3. are living in cars, parks, public spaces, abandoned buildings, substandard

housing, bus or train stations, or similar settings; AND

5.8.1.1.4. migratory children who qualify as homeless for the purposes of this policy

and regulation because the children are living in circumstances described

above.

5.8.2. The term “migratory children” means children who are, or whose parents or spouses are, migratory

agricultural workers, including migratory dairy workers or migratory fishermen, who, in the preceding

36 months, have moved from one school division to another in order to obtain, or accompany such

parent or spouse in order to obtain, temporary or seasonal employment in agriculture or fishing.

5.8.3. The term “school of origin” means the school that the student attended when permanently housed or

the school in which the student was last enrolled.

5.8.4. The term “unaccompanied youth” includes a youth not in the physical custody of a parent or

guardian.


Adopted: 04/10/12

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6. Admission of Nonpublic Students for Part-Time Enrollment

6.1. The Fauquier County School Board acknowledges the provisions for equivalent instruction under Virginia law.

The Board further observes that equivalent or "acceptable alternative" home or private school instruction is not

the same as the education delivered in the public school system.

6.2. The families of non-enrolled students in grades 9-12 who wish to enroll their students on a part-time basis in the

Fauquier County Public Schools may be eligible to do so for participation in classes and/or certain student

activities. Students in grades K-8 are not permitted to enroll in Fauquier County Public schools on a part-time

basis.

6.3. The Superintendent shall develop regulations necessary to provide for part-time enrollment of high school

students in cases where the admission of non-enrolled students will have little/no impact on the admitting

school’s programs and/or services.

7. Non-Residents

7.1. Special Attendance Situations

7.1.1. Upon a determination that the applicant qualifies for admission to the Fauquier County Public Schools

and that space is available in the grade level and/or education program for which the applicant is

qualified, the Superintendent or his/her designee may admit the following persons into the public

schools of the Division in accordance with the criteria and conditions specified below:

8. Tuition Basis

8.1. The following individuals may be admitted, and except as otherwise specifically provided herein, the payment

of tuition and other charges calculated in accordance with paragraph 8 of this policy shall be required as a

condition of admission:

8.1.1. Persons who reside within the school division but who are not of school age.

8.1.2. Persons of school age who are residents of the Commonwealth but who do not reside within the school

division, except as provided in this section.

8.1.3. Persons of school age who are attending school in the school division pursuant to a foreign student

exchange program approved by the school board.

8.1.4. Persons of school age who reside beyond the boundaries of the Commonwealth but near thereto in a

state or the District of Columbia which grants the same privileges to residents of the Commonwealth.

8.1.5. Persons of school age who reside on a military or naval reservation located wholly or partly within the

geographical boundaries of the school division and who are not domiciled residents of the

Commonwealth of Virginia; however, no person of school age residing on a military or naval

reservation located wholly or partly within the geographical boundaries of the school division may be

charged tuition if federal funds provided under P.L. 874 of 1950, commonly known as Impact Aid,

shall fund such students at not less than 50 percent of the total per capita cost of education, exclusive

of capital outlay and debt service, for elementary or secondary pupils, as the case may be, of such

school division.

8.1.6. Persons of school age who, as domiciled residents of the Commonwealth who were enrolled in a

public school within the school division, are required as a result of military or federal orders issued to


Adopted: 04/10/12

Revised: 02/10/14, 08/11/14, 07/13/15

SCHOOL ADMISSIONS

11

their parents to relocate and reside on federal property in another state or the District of Columbia, if

the school division subsequently enrolling such persons is contiguous to such state or District of

Columbia.

8.1.7. Persons of school age who reside in the school division and who are enrolled in summer programs,

exclusive of required remediation as provided in Virginia Code § 22.1-253.13:1, or in local initiatives

or programs not required by the Standards of Quality or the Standards of Accreditation.

9. Non-Tuition Basis

9.1. The Superintendent may admit the following individuals without requiring the payment of tuition, in

accordance with the criteria and conditions below:

9.1.1. An individual who is attending school in the Fauquier County School Division pursuant to a foreign

student exchange program approved by the School Board.

9.1.2. An individual who is a non-resident of the School Division and who has been placed in foster care or

other custodial care or in an orphanage or other children’s home, child-caring institution, or group

home located within the geographical boundaries of the Fauquier County School Division under

circumstances which qualify for reimbursement to the Fauquier County School Division of the cost of

educating the individual in accordance with Code of Virginia, section 22.1-101.1.

9.2. The Fauquier County School Board will consider the application of anyone interested in attending Fauquier

County Public Schools. However, eligibility for consideration does not signify acceptance of the admission

application of a student. Each application for admission will be considered on an individual basis. The

Superintendent may promulgate regulations necessary to implement this policy.

9.3. Foreign students in an F-1 immigration status or who obtain F-1 student visas shall not be admitted in the

Division’s elementary schools or publicly funded adult education programs. Such students may be admitted, for

a period up to twelve (12) months, in the Division’s secondary schools only if they prepay the full, unsubsidized

per capita cost of the education.

10. Procedure for Admission

10.1. The following procedure shall be followed for application and review of applications for admission of non-

resident students. An applicant for admission under this policy shall be deemed “qualified” if the applicant

meets the applicable school age requirements and can participate in the program and activities of the School

Division with or without reasonable accommodation that does not impose undue hardship on the School

Division. In addition, the applicant shall be legally authorized to enter and remain in the United States and to

attend school.

10.2. Access to the Fauquier County Public School shall not be denied to any qualified applicant based upon race,

sex, religion, color, creed, nationality, or disability.

10.3. A parent or guardian of a non-resident student shall apply for admission on behalf of his child by completing

the school division application. The application form shall contain information and agreements including, but

not limited to:

10.3.1. The current legal residence of the child and the school division in which he is currently enrolled;

http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+22.1-253.13C1


Adopted: 04/10/12

Revised: 02/10/14, 08/11/14, 07/13/15

SCHOOL ADMISSIONS

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10.3.2. The child’s social security number, if applicable;

10.3.3. The basis for requesting admission;

10.3.4. The specific building and grade level (elementary) or course offerings (secondary) in which the

student desires to be enrolled if accepted by the school division; and,

10.3.5. The agreement that the student becomes subject to all policies, regulations and guidelines of the

school division, including the Fauquier County Student Code of Conduct.

10.4. Superintendent’s Designee’s Review

10.4.1. Within five (5) administrative days of receipt of the application, the Superintendent’s designee shall

provide written notification of the approval or denial.

10.4.2. If the application is denied, the parent or guardian may appeal the decision by sending a written request

with additional justification to the Superintendent’s designee within five (5) administrative days of

notification. The Superintendent’s designee shall respond in writing to the appeal within three (3)

administrative days.

10.4.3. If the appeal is denied, the Superintendent’s designee shall notify the parent or guardian that they may

make a written request to the Superintendent’s designee for a Superintendent’s conference within three

(3) administrative days of receiving the decision of the Superintendent’s designee.

10.4.4. A failure to make a written request for an appeal within the timelines specified shall constitute a

waiver of the opportunity for appeal and the decision of the Superintendent’s designee shall be final.

10.5. Superintendent’s Conference

10.5.1. The Superintendent shall schedule a conference within five (5) administrative days of the request. The

requesting party and Superintendent’s designee will be invited to attend the conference. At this

conference, the Superintendent shall review the record of the Request for Out-of-County Tuition

Status. Further, the Superintendent may hear from the requesting party and the Superintendent’s

designee. Within three (3) administrative days of the conference, the Superintendent shall issue a

decision granting or denying the Request for Out-of-County Tuition Status.

10.5.2. The decision of the Superintendent is final.

10.5.3. After approval of application, the parent must complete school enrollment papers and meet the

additional admission requirements.

11. Tuition

11.1. Tuition charged pursuant to this policy shall be equivalent to the total per capita cost of education, exclusive of

capital outlay and debt service. However, if the tuition charge is payable by the School Board of the School

Division of the student’s residence pursuant to a contract entered into between the two (2) School Boards, the

tuition charge shall be that fixed by such contract.

11.2. Payment of tuition shall be in advance and continued access to programs and activities of the School Division

shall be subject to the payment of all fees and charges.


Adopted: 04/10/12

Revised: 02/10/14, 08/11/14, 07/13/15

SCHOOL ADMISSIONS

13

12. Transportation

12.1. Transportation shall not be furnished to non-resident students except in those cases where:

12.1.1. Agreements between Divisions specify transportation services; or

12.1.2. Federal or state legislation mandates the provision of transportation services; or

12.1.3. Transportation services can be provided at no cost to the Division.

13. Contracts

13.1. This policy does not preclude contractual arrangements between the Fauquier County School Board and

agencies of the federal government or the School Board of another jurisdiction to permit students who are not

otherwise eligible to attend Fauquier County Public Schools.

14. Special Exceptions

14.1. School Division/County Government Employees - In implementing this policy, the Superintendent may make a

special exception for the admission of children of Fauquier County School Division and Fauquier County

Government employees who are non-residents of Fauquier County under the following circumstances:

14.1.1. Children of non-residents employed by the Fauquier County School Division and the Fauquier County

Government may be eligible for this special exception while the parent is a full-time, permanent

employee of the Fauquier County School Division or the Fauquier County Government. Such children

shall be enrolled in the school that serves the geographical zone for the school or facility in which the

child’s parent is assigned to work. For the purposes of this exception, school bus drivers and aides are

considered full-time, permanent employees.

14.1.2. Such non-resident employees who elect to place their children in Fauquier County Public Schools will

not be charged a tuition cost, so long as the child or children are residents of Virginia.

14.1.3. The parent shall be responsible for the child’s transportation to and from school.

14.1.4. For purposes of this special exception, the term “parent” shall include legal guardian.

LEGAL REFERENCE: Code of Virginia, 1950, as amended, §§ 22.1-1, 22.1-3, 22.1-3.1, 22.1-3.2, 22.1-3.4, 22.1-5, 22.1-

70, 22.1-78, 22.1-79, 22.1-200.1, 22.1-253.13:1, 22.1-254.1, 22.1-255, 22.1-260, 22.1-270, 22.1-271.1, 22.1-271.2, 22.1-

271.4, 22.1-276.01, 22.1-277, 22.1-277.2, 22.1-288.2, 32.1-43, 32.1-46, 32.1-48; 63.2-900, and 63.2-1200; Public Law 104-

208, Illegal Immigrations Reform and Immigrant Responsibility Act of 1996, § 625; Steward B. McKinney Homeless

Assistance Act, Subtitle VII-B (P.L. 101-645); Immigration and Nationality Act, as amended, 8 U.S.C §§ 1101, et seq.; 8

CFR Parts 1 – 499; and 22 CFR Parts 1 - 1799.

Regulations and Forms Follow


Adopted: 04/10/12

Revised: 02/10/14, 08/11/14, 07/13/15

SCHOOL ADMISSIONS

14

ACCOMPANYING REGULATIONS/FORMS

REGULATION 7-2.3 (A) REGULATIONS FOR ADMISSION OF NON-PUBLIC SCHOOL STUDENTS FOR

PART-TIME ENROLLMENT; APPLICATION

REGULATION 7-2.3 (B) STUDENT IMMUNIZATIONS

REGULATION 7-2.3 (C) PHYSICAL EXAMINATIONS OF STUDENTS

FORM 7-2.3F1

FORM 7-2.3F1S

FORM 7-2.3F2

FORM 7-2.3 (A)F1

FORM 7-2.3 (A)F2

FORM 7-2.3 (A)F3

FORM 7-2.3 (B)F1

FORM 7-2.3 (B)F2

STUDENT ENROLLMENT FORM

SPANISH STUDENT ENROLLMENT FORM

REQUEST FOR OUT OF COUNTY TUITION STATUS

APPLICATION FOR PART-TIME ENROLLMENT (GRADES 9-12)

AFFIDAVIT – PENDING CERTIFIED COPY OF BIRTH CERTIFICATE

CRIMINAL CONVICTION, JUVENILE DELINQUENCY ADJUDICATION, AND HISTORY

OF EXPULSION AFFIRMATION

SCHOOL ENTRANCE HEALTH FORM – CERTIFICATE OF IMMUNIZATIONS

CERTIFICATE OF RELIGIOUS EXEMPTION – IMMUNIZATIONS

Regulations and Forms Follow


Adopted: 04/10/12

Revised: 02/10/14, 08/11/14, 07/13/15

SCHOOL ADMISSIONS

1

REGULATION 7-2.3 (A) REGULATIONS FOR ADMISSION OF NON-PUBLIC SCHOOL STUDENTS FOR

PART-TIME ENROLLMENT

1. Admission

1.2. Parents shall identify their children as private school or home school students who desire part-time enrollment

in academic courses of study. Students admitted under this policy shall be designated as part-time students.

1.3. Students admitted under this regulation must be residents of Fauquier County.

2. Enrollment

2.1. The parent/guardian of non-enrolled students in grades 9-12 may enroll students on a part-time basis in the

Fauquier County Public Schools for participation in a maximum of two classes per school term. Part-time

students must enroll in the full length of the course.

2.2. Students may participate in a co-curricular activity which is directly related to the class in which they are

enrolled.

2.2.1. Part-time students shall participate in co-curricular activities which are required as a result of

enrollment in certain classes (orchestra, band, chorus, drama, etc.).

2.2.2. Part-time students may participate in optional co-curricular activities which are directly related to the

class in which they are enrolled (Spanish Club, Math Club, Art Club, etc.).

2.2.3. Part-time students may not participate in extra-curricular activities, such as those sponsored by the

Virginia High School League (athletics, cheerleading, Theatre Festival, etc.).

3. Procedures

3.1. A “Part-Time Enrollment” application (see attached) must be submitted to the principal of the attending school

by July 1 for first term and December 1 for second term.

3.2. The school principal will review this application and determine availability of space based upon:

3.2.1. Locally adopted maximum students per class: no more than 24 in English and 25 in other courses.

3.2.2. The number of students enrolled as of August 1 in each class plus five (5) students to allow for

growth.

3.3. If the proposed part-time enrollment would result in the purchase of additional equipment or the employment of

additional staff, the request shall be forwarded to the Superintendent. The Superintendent may request

additional funding.

3.4. The school principal will forward a copy of the application to the Superintendent with a recommendation for

approval or denial of the request for part-time enrollment, based on criteria stated above.

3.5. The Superintendent will approve or deny the request based on the principal’s recommendation and/or the

conditions referenced above.


Adopted: 04/10/12

Revised: 02/10/14, 08/11/14, 07/13/15

SCHOOL ADMISSIONS

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4. Conditions

4.1. Part-time enrollment is determined annually and there will be no guarantee that it will be continued from one

year to the next.

4.2. Part-time students shall abide by all the policies and regulations of Fauquier County Public Schools. These

policies include, but are not limited to, the Code of Conduct, the completion of all coursework in a satisfactory

manner, and the attendance policy. The parent or guardian will be required to sign the Code of Conduct and

accept liability for any property damage done by the student. Violation of rules and regulations will be cause for

the Superintendent to review participation of the student in any program/activity, and could result in immediate

dismissal.

4.3. Part-time students must meet equivalent pre-requisite requirements to be enrolled in a course.

4.4. Class ranking and grade point average shall not be computed for part-time enrolled students, and such students

shall not be eligible to graduate or receive a diploma from the Fauquier County Public Schools.

4.5. Part-time enrolled students shall not participate in activities other than those which are specified in 2.3

(excluded activities include prom and field trips related to enrolled course).

4.6. Transportation to and from school will be the responsibility of the family. Those admitted under this policy will

be subject to the same rules and fees regarding parking as fully enrolled students.

4.7. Full time students will be given first consideration for parking on the high school campus.

4.8. Part-time students, when attending classes in the public schools, must sign in and out of the school by

following the building level procedure.

4.9. Part-time students are to be present on school grounds only when their selected course/activity is in session. It

is the responsibility of the part-time student to be aware of any changes in the schedule during inclement

weather or for other reasons.

4.10. Part-time students must take all required tests in a course, including state end-of-course tests.

5. Restrictions

5.1. The parent/guardian of non-enrolled students in grades K-8 may not enroll students on a part-time basis in

Fauquier County Public Schools nor may non-enrolled students in grades K-8 participate in co- or extra-

curricular activities.


Adopted: 04/10/12

Revised: 02/10/14, 08/11/14, 07/13/15

SCHOOL ADMISSIONS

1

REGULATION 7-2.3(B) STUDENT IMMUNIZATIONS

1. Generally

1.1. Before entering a Fauquier County public school for the first time, every pupil shall furnish a certificate

confirming that the pupil has been immunized against communicable diseases as required by §§ 32.1-46, 22.1-

271.2 and 22.1-271.4 of the Code of Virginia, has begun receiving the first series of all such vaccinations, or is

exempt as provided elsewhere in this regulation. Any parent, guardian, or other person having control or charge

of a child being home instructed or exempted or excused from school attendance shall comply with state

immunization requirements.

2. Immunization Requirements

2.1 Diphtheria and Tetanus Toxoids and Pertussis Vaccine (DPT, DTaP, Tdap) – A minimum of 3 doses. A child

must have at least one dose of DTaP or DTP vaccine on or after the fourth birthday. If the child has received six

doses of DTaP or DTP before the fourth birthday, additional doses are contraindicated. DT (Diphtheria,

Tetanus) vaccine is required for children who are medically exempt from the pertussis containing vaccine

(DTaP or DTP). Adult Td is required for children seven (7) years of age and older who do not meet the

minimum requirements for tetanus and diphtheria. Effective July 1, 2006, a booster dose of acellular pertussis

vaccine shall be administered prior to entry into the sixth grade.

2.2. Measles, Mumps, Rubella (MMR) Vaccine – A minimum of two (2) measles, one (1) mumps, and one (1)

rubella. (Most children receive two (2) doses of each because the vaccine usually administered is the

combination vaccine MMR). First dose must be administered at age 12 months (365 days) or older. If first dose

is administered before 12 months of age, the dose does not count and must be repeated. Second dose of measles

vaccine does not have to be administered until age four (4) – six (6) years (usually at entry to kindergarten) but

can be administered at any time after the minimum interval between dose one (1) and dose two (2). The

minimum interval is four (4) weeks (28 days).

2.3. Haemophilus Influenza Type b (Hib) Vaccine* – This vaccine is required ONLY for children up to 60 months

of age. A primary series consists of either two (2) or three (3) doses (depending on the manufacturer) followed

by a booster dose at age 12-15 months. However, the child's current age and not the number of prior doses

received govern the number of doses required. Unvaccinated children between the ages of 15 and 60 months are

only required to have one dose of vaccine.

2.4. Hepatitis B Vaccine – A complete series of three (3) doses of hepatitis B vaccine is required for all children.

However, the FDA has approved a two (2)-dose schedule ONLY for adolescents 11-15 years of age AND

ONLY when the Merck Brand (RECOMBIVAX HB) Adult Formulation Hepatitis B Vaccine is issued. The two

(2) RECOMBIVAX HB Adult doses must be separated by a minimum of four (4) months. If the three (3)-dose

hepatitis B vaccine schedule is used, there should be at least one (1) month spacing between the 1st and 2nd

doses and four (4) months spacing between the 1st and 3rd doses.

2.5. Pneumococcal (PCV) Vaccine – One (1) to four (4) doses, dependent on age at first dose, of pneumococcal

conjugate vaccine for children up to 60 months of age.

2.6. Polio Vaccine - A minimum of three (3) doses of all IPV or all OPV polio vaccine. If a child has had only three

doses of polio vaccine, one dose must have been administered on or after the fourth birthday. However, a child

who has received four (4) doses of any combination of IPVor OPV polio vaccine before the fourth birthday is

adequately immunized and does not need a dose after the fourth birthday.


Adopted: 04/10/12

Revised: 02/10/14, 08/11/14, 07/13/15

SCHOOL ADMISSIONS

2

2.7. Varicella Vaccine (Chickenpox) – All children born on and after January 1, 1997, shall be required to have a

dose of chickenpox vaccine not earlier than the age of 12 months (365 days).

2.8. Human Papillomavirus (HPV) Vaccine – Three (3) doses of properly spaced HPV vaccine for females. The

first dose shall be administered before the child enters the sixth grade.

NOTE: The four (4)-day grace period for administration of vaccines does not apply to MMR vaccine or Varicella vaccine.

3. Conditional Enrollment

3.1. A student may be enrolled for a period of 90 school days contingent upon the student's having received at least

one dose of each of the required vaccines and the student's possessing a plan, from a physician, registered nurse

or employee of a local health department, for completing his immunization requirements within the ensuing 90

school days; except that a student who has not yet received a second dose of measles (rubeola) vaccine must

receive such second dose pursuant to the Virginia Board of Health’s minimum immunizations required for

school attendance. The admitting official shall, at the end of the conditional enrollment period, exclude any

student who is not in compliance with the immunization requirements and who has not been granted an

exemption, until that student provides documentary proof that his/her immunization schedule has been

completed, unless documentary proof that a medical contraindication developed during the conditional

enrollment period is submitted.

4. Exemptions

1. When the parent or guardian has an objection on the grounds that the administration of immunizing agents

conflicts with his religious tenets or practices and provides the principal with a written statement of such

objection, unless an emergency or a disease epidemic has been declared by the Virginia Board of Health.

2. When the parent or guardian presents a statement from a physician or a local health department that states that

the physical condition of the child is such that the administration of one or more of the required immunizing

agents would be detrimental to the health of the child.

5. Homeless Students

5.1. If a student is a homeless child or youth as defined in Va. Code Section 22.1-3 and does not have documentary

proof of necessary immunizations or has incomplete immunizations and is not exempted from immunization,

the School Division will immediately admit such student and will immediately refer the student to the local

School Division homeless liaison who will assist in obtaining the documentary proof of, or completing,

immunization.

6. Evidence of Immunization

6.1. Evidence acceptable for proof of required immunizations must include the month, day, and year each dosage

was administered on forms developed by or approved by the Virginia Department of Health. All students for

whom immunization dates cannot be provided (month, day, year) must be referred to the local health

department or their private physicians to update their records before entering school.

7. Transfer of Records

7.1. The admitting official of every school shall be responsible for sending a student’s immunization records or a

copy thereof, along with his/her permanent academic or scholastic records, to the admitting official of the

school to which a student is transferring within 30 days of his/her transfer to the new school.


Adopted: 04/10/12

Revised: 02/10/14, 08/11/14, 07/13/15

SCHOOL ADMISSIONS

3

8. Report of Student Immunization Status

8.1. Each admitting official shall, within 30 days of the beginning of each school year or entrance of a student, or by

October 15 of each school year, file with the State Health Department through the health department for his/her

locality, a report summarizing the immunization status of the students in his/her school. This report shall be

filed on Form SIS, the Student Immunization Status report, and shall contain the number of students admitted

with a medical or religious exemption and the number of students who have been conditionally admitted.

9. Penalties

9.1. Any student who fails to provide documentary proof of immunization in the manner prescribed, within the time

periods provided, shall be excluded from school attendance by the school’s admitting official.

9.2. Any student exempted from immunization requirements shall be excluded from school attendance for his/her

own protection until the danger has passed, if the commissioner so orders such exclusion upon the identification

of an outbreak, potential epidemic, or epidemic of a vaccine-preventable disease in that student’s school.

9.3. Any person, willfully violating or refusing, failing or neglecting to comply with any regulation order of the

Board of Commissioner of any provision of the Code of Virginia shall be guilty of a Class 1 misdemeanor,

unless a different penalty is specified.


Adopted: 04/10/12

Revised: 02/10/14, 08/11/14, 07/13/15

SCHOOL ADMISSIONS

1

REGULATION 7-2.3(C) PHYSICAL EXAMINATIONS OF STUDENTS

1. Physical Examinations and Reports

1.1. Before any child is admitted for the first time to any public preschool, kindergarten, or elementary school

(grades K-6), such child must furnish a report from a qualified licensed physician or a licensed nurse

practitioner acting under the supervision of a licensed physician, of a comprehensive physical examination of a

scope as prescribed by the Virginia Health Commissioner, performed within the twelve (12) months prior to the

date such child first enters kindergarten or elementary school. At the end of such report shall summarize

abnormal physical findings, if any, and shall specifically state what, if any, conditions are found that would

identify the child as disabled.

1.1.1. A copy of such report must be presented to the school on the child's behalf.

1.1.2. The report must indicate that the child has received the physical examination no earlier than 12 months

prior to the date of first entering kindergarten or elementary school.

1.2. Transfer students entering a Fauquier County elementary school must provide one of the following:

1.2.1. Records establishing that a physical examination was completed prior to enrolling in another school

(evidence of such an examination may be: (a) a copy of the report of the medical examination or (b)

transcript notation or phone verification from the other school with records to follow); OR

1.2.2. A report of a physical examination dated within the last 12 months.

1.3. Physical examination reports shall be placed in the child's health record at the school.

1.4. A physical examination shall not be required of any child whose parent or guardian objects on religious grounds

and who shows no visible evidence of sickness. The parent or guardian shall state in writing that, to the best of

his knowledge, the child is in good health and free from any communicable or contagious disease.

1.5. The school division shall coordinate with the Fauquier County Department of Health to conduct physical

examinations for medically indigent children, upon request, before their admission to any kindergarten or

elementary school, without charge to the children or their parents or guardians.

1.6. Parents/guardians of students entering school shall complete a health information form as required by state

law. (See attached). Such forms shall be returned within fifteen (15) days of receipt unless reasonable

extensions have been granted by the superintendent or his designee. Failure to return the form as required by

state law may result in the child's exclusion from school; however, no child who is a homeless child or youth as

defined in subdivision six (6) of Virginia Code § 22.1-3, shall be excluded from school for failure to complete

such form.

Forms Follow

7-2.3F1 Revised 3/21/2017

FAUQUIER COUNTY PUBLIC SCHOOLS

INITIAL ENROLLMENT FORM

1

7-2.3F1 Revised 3/21/2017

Date:

Has This Student Ever Attended Fauquier County Public Schools? Yes No Has This Student Ever Attended School In Virginia? Yes No

Student is not military connected. Student is a dependent of a member of the Active Duty Forces (full time) Army, Navy, Air Force, Marines, or Coast Guard,

the Commissioned Corps of the Nat’l Oceanic & Atmospheric Admin., or the Commissioned Corps of the U.S. Public Health Services. Reserve; student is a dependent of a member of the Reserve Forces (Army, Navy, Air Force, Marine Corps, or Coast Guard) National Guard, active or reserve duty; student is a dependent of a member of the National Guard (and not a dependent of a member of

the U.S. Armed Forces.)

Student Information (Section A)

Last Name: First Name:

Middle Name: Nickname:

Gender: Male Female Birth Certificate Number:

Date of Birth:

Place of Birth: City/County: State: Country:

Race/Ethnicity – Please Answer Questions 1 and 2 as Instructed Below*:

1. Is The Student Hispanic or Latino? (Choose Only One.) No, Not Hispanic or Latino Yes, Hispanic or Latino

2. What Is the Student’s Race? (Choose One Or More.) American Indian or Alaskan Native White Native Hawaiian or Other Pacific Islander Black or African American Asian

*The Federal Government Requires the Use of “Observer” Identification of Elementary and Secondary School Students’ Race and Ethnicity, as a Last Resort, if Such Information Is Not Provided by the Students and Their Parents or Guardians.

Did This Student Attend Kindergarten? Yes No

Has Student Repeated Any Grade? Yes No If So, Which Grade(s)? Last Grade Completed

Name of Last School Attended: Address:

Date of Withdrawal from Last School:

Home Schooled Grade Level(s):

Has the Student Ever Been Eligible for Special Education Services? Yes No

Is the Student Currently Eligible for Special Education Services? Yes No

Does the Student Currently have a 504 Plan? Yes No

Is the Student Currently Receiving Gifted Services? Yes No

Has your child ever received ESL services? Yes No

Newly Enrolled Kindergarten Students Only (Section B)

Did This Student Attend Preschool? Yes No

If yes, pick the PK experience code that applies.

1 Head Start

2 Public Preschool

3 Private Preschool/Daycare

For Office Use Only: School: _________ Student ID#: _________ Entry Date: __________ Entry Code: _________ IEP/504: ___________ Grade: _________

7-2.3F1 Revised 3/21/2017



2

7-2.3F1 Revised 3/21/2017

4 Dept. of Defense Child Development Program

5 Family Home Daycare Provider

6 No Preschool Experience

How many hours per week was the child in preschool or cared for by a home provider? Select one:

0 No time in a formal or institutional PK program.

1 Less than 15 hours per week.

15 15 or more but less than 30 hours per week.

30 30 or more hours per week.

Was the PK experience in Fauquier County? Yes No

Student Address (Section C)

Street Address: City: Zip Code:

Home/Main Number: Mailing Address (if Different Than Street Address):

If the Student Does Not Reside with the Parent or Guardian, Provide the Name of Person with Whom the Student Resides: Relationship of Person to Student:

Parent Information (Section D)

Father’s LEGAL Name: Mother’s LEGAL Name:

Father’s Date of Birth: Mother’s Date of Birth:

Street Address (If Different from Student):

Street Address (If Different from Student):

Mailing Address (If Different from Street Address):

Mailing Address (If Different from Street Address):

Occupation: Occupation:

Employer: Employer:

Business Telephone: Business Telephone:

Cell/Pager: Cell/Pager:

E-Mail: E-Mail:

Are You the Legal Guardian of This Student? Yes No

Are You the Legal Guardian of This Student? Yes No

Please check this box if there are any court documents specifying guardianship or limitations of which the school must be aware, e.g., legal guardian, limited parental visitation, or pick up, severed parental educational rights. These documents will need to be provided to the school.

Legal Guardian (If Other Than Parent) (Section E)

Name(s): Cell/Pager:

Telephone Number: E-Mail:

Occupation: Employer:

Business Telephone:

Foster Information (Section F)

Foster Parent Name(s): Telephone:

Cellular: Foster Placing Agency:

Case Worker Name: Agency Location:

Case Worker Telephone:

Sibling Information: (Section G)

Last Name First Name Middle Name Date Of Birth

7-2.3F1 Revised 3/21/2017



3

7-2.3F1 Revised 3/21/2017

Complete This Box To Reflect Your Child’s Current Living Situation: (Section H)

(Your Answer May Enable the Student to Receive Additional Services Under the

McKinney-Vento Assistance Act.) Check One Box That Best Describes the Student’s Living Situation:

In Permanent Home with Parent or Guardian With Relative or Others Due to Lack of Housing In a Motel/Hotel or Other Similar Situation Due to Lack of Alternative, Adequate

Housing In a Shelter At a Park or in a Car Temporarily Housed in a Shelter Awaiting Department of Social Services

Permanent Foster Placement. Youth Not Living With a Parent or Guardian Other Situation with No Fixed Address (Specify):

Residency Certification (Section I) Per Code of Virginia 22.1-264.1, It Is a Class 4 Misdemeanor to Make a False Statement As to Residency. Making a False Statement Regarding Residency May Incur Liability for Tuition as a Non-Resident Student and/or Court Imposed Fines.

Please Complete Either Option A, B, C, or D:

A. This Is to Certify That , for Whom Enrollment Is Requested in Fauquier County Public Schools, Resides According to the Fauquier County Public Schools Policy, Within the Boundaries of the School Zone.

B. This Is to Certify That , for Whom Enrollment Is Requested in Fauquier County Public Schools, Does Not Reside Within the Boundaries of the School Zone and a Special School Zone Request Was Granted for the Current School Year.

C. This Is to Certify That , for Whom Enrollment Is Requested in Fauquier County Public Schools, Does Not Reside Within the Boundaries of Fauquier County and Request for Out-of-County Tuition Status Has Been Granted for the Current School Year.

D. This Is to Certify That , for Whom Enrollment

Is Requested in Fauquier County Public Schools, Does Not Presently Have a Fixed and Regular Nighttime Residence, Has Requested to Be Allowed to Enroll Pursuant to Policy, and Has Completed Section H.

Fauquier County Public Schools Shall Be Free to Each Person of School Age Who Resides Within the County of Fauquier. Tuition Is Regularly Charged to Other Persons Requesting Admission. A False Certification May Result in Legal Action to Recover Tuition Charges. ___________________________________ __________________

Signature of Parent or Guardian Date Completed with the assistance of:

___________________________________ __________________ Signature Date

7-2.3F1 Revised 3/21/2017



4

7-2.3F1 Revised 3/21/2017

For Office Use Only To the Principal: According to FCPS Policy, Two Proof of Residency Documents Are Required: At Least One at the Time of Initial Enrollment and a Second Within 30 Days of Enrollment. Please Check the Types of Proof Provided:

Housing Contract Rental Agreement/Letter from Owner or Landlord. (Must Be Notarized.) Property Tax Bill Utility Bill (Cellular Telephone Bills Are Not Accepted.)

A Driver’s License Is Not Acceptable Proof of Residency. In Lieu of the Proof of Residency Documents, The Documents Required In Option D Above May Be Accepted. _____________________________________ __________________ Signature of Principal or Designee Date

An Inspection of Your Child’s Records Is Available upon Request.

Distribution: Initial Enrollment Form Should Be Kept In Permanent Cumulative File. Do Not Purge.

7-2.3F1S ENGLISH/SPANISH Revised 3/21/2017


INITIAL ENROLLMENT FORM FORMULARIO INICIAL DE MATRICULACIÓN

1 7-2.3F1S

Revised 3/21/2017

Date/Fecha:

Has This Student Ever Attended Fauquier County Public Schools? ¿El estudiante asistió anteriormente a las Escuelas Públicas del Condado de Fauquier? Yes/Sí No Has This Student Ever Attended School In Virginia? ¿El estudiante asistió anteriormente a alguna escuela pública en el Estado de Virginia? Yes/Sí No

Student is not military connected./ El estudiante no tiene conexiones militares. Student is a dependent of a member of the Active Duty Forces (full time) Army, Navy, Air Force, Marines, or Coast Guard, the

Commissioned Corps of the Nat’l Oceanic & Atmospheric Admin., or the Commissioned Corps of the U.S. Public Health Services. El estudiante es un dependiente de un miembro en Servicio Activo (a tiempo completo) de las Fuerzas Armadas, Navales, Aéreas, Infantería de Marina o Guardia Costera, o de funcionarios que pertenezcan al Cuerpo de Comisión de Servicios de la Administración Nacional Oceánica y Atmosférica o al Cuerpo de Comisión de Servicios de la Salud Pública.

Reserve; student is a dependent of a member of the Reserve Forces (Army, Navy, Air Force, Marines, or Coast Guard) La Reserva; el estudiante es un dependiente de un miembro de las Fuerzas de Reserva (Fuerzas Armadas, Naval, Aérea, Infantería de Marina o Guardia Costera.

National Guard, active or reserve duty; student is a dependent of a member of the National Guard (and not a dependent of a member of the U.S. Armed Forces.) Guardia Nacional, en servicio activo o reserva; el estudiante es un dependiente de un miembro de la Guardia Nacional (y no es un dependiente de un miembro de las Fuerzas Armadas de los Estados Unidos.

Student Information (Section A)/ (Sección A) Información sobre el estudiante Last Name/Apellido: First Name/Primer nombre:

Middle Name/Segundo nombre: Nickname/Apodo:

Gender/Sexo: Male/Masculino Female/ Femenino Birth Certificate Number/ Número de certificado de nacimiento :

Date of Birth/Fecha de nacimiento:

Place of Birth/Lugar de nacimiento: City/County/Ciudad/Condado: State/Estado: Country/País:

Race/Ethnicity – Please Answer Questions 1 and 2 as Instructed Below*:

Raza/Grupo étnico – Por favor responda a las preguntas 1 y 2 tal como se indica a continuación**:

1. Is The Student Hispanic or Latino? (Choose Only One.) /El estudiante ¿es hispano o latino? (Sólo marque una) No, Not Hispanic or Latino/ No, no es hispano o latino Yes, Hispanic or Latino/ Sí, es hispano o latino

2. What Is the Student’s Race? (Choose One Or More.) / ¿De qué raza es el estudiante? (Puede marcar más de una) American Indian or Alaskan Native/Indígena americana o nativa de Alaska White/Blanca Native Hawaiian or Other Pacific Islander /Nativa de Hawai u otra isla del Pacífico Black or African American /Negra o Afroamericana Asian/Asiática

*The Federal Government Requires the Use of “Observer” Identification of Elementary and Secondary School Students’ Race and Ethnicity, as a Last Resort, if Such Information Is Not Provided by the Students and Their Parents or Guardians. **Si los padres o los tutores no proporcionan la información solicitada, el Gobierno Federal requiere que un “observador” determine la raza y el grupo étnico al que pertenece el estudiante de la escuela secundaria o primaria.

Did This Student Attend Kindergarten? / Asistió el estudiante a Kinder? Yes/Sí No

Has Student Repeated Any Grade?/¿Repitió algún grado? Yes/Sí No If So, Which Grade(s)? ¿Qué grado? Last Grade Completed/¿Cuál fue el último grado que cursó?/

Name of Last School Attended /Nombre de la última escuela a la que asistió: Address/Dirección:

Date of Withdrawal from Last School / Fecha en que dejó la última escuela:

Home Schooled Grade Level(s) /Nivel o grado de la Instrucción Académica en Casa:

Has the Student Ever Been Eligible for Special Education Services? ¿Alguna vez recibió servicios de Educación Especial? Yes/ Sí No

Is the Student Currently Eligible for Special Education Services? ¿Está recibiendo servicios de Educación Especial en este momento? Yes/Sí No

For Office Use Only: School: _________ Student ID#: _________ Entry Date: __________ Entry Code: _________ IEP/504: ___________ Grade: _________




2 7-2.3F1S

Revised 3/21/2017

Does the Student Currently have a 504 Plan? ¿Tiene actualmente un Plan 504? Yes/Sí No

Is the Student Currently Receiving Gifted Services? ¿Está recibiendo servicios del Programa de Aptitud y Talento en este momento? Yes/Sí No

Has your child ever received ESL services? ¿Ha recibido alguna vez servicios de ESL? Yes/Sí No

Newly Enrolled Kindergarten Students Only (Section B) (Sección B) Solo para Estudiantes Recientemente Matriculados a Kindergarten

Did This Student Attend Preschool? / ¿El estudiante asistió a un centro preescolar? Yes/ Sí No

If yes, pick the PK experience code that applies./Si respondió que “Sí”, marque la opción de PK que corresponda:

1 Head Start / Programa de “Head Start”

2 Public Preschool / Preescolar Público

3 Private Preschool/Daycare / Preescolar/Guardería Privada

4 Dept. of Defense Child Development Program / Programa del Desarrollo del Niño del Departamento de Defensa

5 Family Home Daycare Provider / Proveedor de Guardería o Cuidado de Niños en una Vivienda Familiar

6 No Preschool Experience / Sin Experiencia Preescolar.

How many hours per week was the child in preschool or cared for by a home provider? Select one: ¿Cuántas horas por semana asistía al preescolar o estaba a cargo de un cuidador(a) en un hogar? Marque solo una:

0 No time in a formal or institutional PK program/ No asistió a ninguna institución o programa formativo preescolar.

1 Less than 15 hours per week / Menos de 15 horas por semana.

15 15 or more but less than 30 hours per week/ Más de 15 horas pero menos de 30 horas por semana.

30 30 or more hours per week/ 30 horas o más por semana.

Was the PK experience in Fauquier County? / ¿Asistió a un centro preescolar en el Condado de Fauquier? Yes/ Sí No

Student Address (Section C) / (Sección C) Dirección del estudiante Street Address/Dirección:______________________________________________ City/Ciudad: ______________ Zip Code / Código postal: ___________________ Home/Main Number/ Número de teléfono principal: ____________ Mailing Address (if Different Than Street Address)/Dirección postal si es diferente de la dirección donde reside:

If the Student Does Not Reside with the Parent or Guardian, Provide the Name of Person with Whom the Student Resides: Relationship of Person to Student: Si el Estudiante no reside con el Padre o Guardián, escriba el nombre de la persona con quien reside: Relación de la Persona con el Estudiante:

Parent Information (Section D)/ (Sección D) Información de los padres Father’s LEGAL Name/Nombre LEGAL del padre:

Mother’s LEGAL Name/Nombre LEGAL de la madre:

Father’s Date of Birth/Fecha de nacimiento del padre:

Mother’s Date of Birth/Fecha de nacimiento de la madre:

Street Address (If Different from Student)/Dirección si es diferente a la del estudiante:

Street Address (If Different from Student) /Dirección si es diferente a la del estudiante:

Mailing Address (If Different from Street Address) /Dirección Postal si es diferente a la de su residencia:

Mailing Address (If Different from Street Address) /Dirección Postal si es diferente a la de su residencia:

Occupation/Ocupación: Occupation/Ocupación:

Employer/Empleador: Employer/Empleador:

Business Telephone/Teléfono del trabajo: Business Telephone/Teléfono del trabajo:

Cell/Pager/Celular/Bíper: Cell/Pager/Celular/Bíper:

E-Mail: E-Mail:

Are You the Legal Guardian of This Student? ¿Es usted el tutor legal del estudiante? Yes/Sí No

Are You the Legal Guardian of This Student? ¿Es usted el tutor legal del estudiante?

Yes/Sí No




3 7-2.3F1S

Revised 3/21/2017

Please check this box if there are any court documents specifying guardianship or limitations of which the school must be aware, e.g., legal guardian, limited parental visitation, or pick up, severed parental educational rights. These documents will need to be provided to the school.

Por favor marque la casilla si tiene documentos de la corte, que especifiquen la tutoría o limitaciones de las cuales la escuela debería tener conocimiento, p.ej., tutoría legal, visita o retiro limitado de los niños por parte de sus padres, derechos educativos excluídos de los padres.

Legal Guardian (If Other Than Parent) (Section E) Sección E Tutor Legal (en caso de no ser el padre o la madre)

Name(s)/Nombre(s): Cell/Pager/Celular/Bíper:

Telephone Number/Número de teléfono: E-Mail:

Occupation/Ocupación: Employer/Empleador:

Business Telephone/Teléfono del trabajo:

Foster Information (Section F)/ (Sección F) Información acerca del Hogar de Crianza

Foster Parent Name(s)/ Nombre del padre o madre de crianza:

Telephone/Teléfono:

Cellular/Celular: Foster Placing Agency/Agencia encargada:

Case Worker Name/Nombre del Asistente Social:

Agency Location/Dirección de la agencia:

Case Worker Telephone/ Teléfono del Asistente Social:

Sibling Information: (Section G)/ (Sección G) Información de los hermanos:

Last Name/ Apellido First Name/Primer Nombre Middle Name/Segundo Nombre Date Of Birth/Fecha de nacimiento

Complete This Box To Reflect Your Child’s Current Living Situation: (Section H) (Sección H) Llene el siguiente cuestionario acerca de la situación de vivienda actual de su hijo(a):

(Your Answer May Enable the Student to Receive Additional Services Under the Mckinney-Vento Assistance Act.)

(Sus respuestas permitirán establecer si el estudiante puede recibir servicios adicionales de acuerdo con la Ley de Asistencia McKinney-Vento)

Check One Box That Best Describes the Student’s Living Situation/Marque la opción (Sólo Una) que mejor describe la situación actual de vivienda del estudiante:

In Permanent Home with Parent or Guardian/Vive en un hogar permanente con el padre y/o madre o tutor. With Relative or Others Due to Lack of Housing/Vive con parientes debido a que no tiene vivienda. In a Motel/Hotel or Other Similar Situation Due to Lack of Alternative, Adequate

Housing/Vive en un motel/hotel u otro lugar similar por falta de una vivienda alternativa o adecuada. In a Shelter/Vive en un albergue o casa de refugio At a Park or in a Car/Vive en un parque o en un coche

Temporarily Housed in a Shelter Awaiting Department of Social Services Permanent Foster Placement./Vive temporalmente en una casa de refugio esperando que el Departamento de Servicio Social lo ubique en un hogar de crianza.

Youth Not Living With a Parent or Guardian/Joven que no vive con sus padres o tutor. Other Situation with No Fixed Address (Specify)/Otro tipo de arreglo de vivienda y sin domicilio fijo(explique):

Residency Certification (Section I)/ (Sección I) Certificación de Residencia

Per Code of Virginia 22.1-264.1, It Is a Class 4 Misdemeanor to Make a False Statement As to Residency. Making a False Statement Regarding Residency May Incur Liability for Tuition as a Non-Resident Student and/or Court Imposed Fines. Conforme al Código de Virginia 22.1-264.1, es un delito menor de clase 4 hacer una declaración falsa en cuanto a la residencia. Si hace una declaración falsa referente a su residencia, es posible que se sea responsable de pagar los gastos de instrucción como si fuera un estudiante no residente y los gastos que imponga el juez. Please Complete Either Section A, B, C, or D/Por favor llene la parte A, B, C o D:




4 7-2.3F1S

Revised 3/21/2017

A. This Is to Certify That ____________________________________, for Whom Enrollment Is Requested in Fauquier County Public Schools, Resides According to the Fauquier County Public Schools Policy, Within the Boundaries of the ______________________School Zone.

Certifico que _______________________________ a quien solicito se matricule en las Escuelas Públicas del Condado de Fauquier, reside dentro de los límites correspondientes a la escuela _____________________ B. This Is to Certify That ____________________________________, for Whom Enrollment Is Requested in Fauquier County

Public Schools, Does Not Reside Within the Boundaries of the ________________ School Zone and a Special School Zone Request Was Granted for the Current School Year. Certifico que _____________________________ a quien solicito se matricule en las Escuelas Públicas del Condado de Fauquier no reside dentro de los límites correspondientes a la escuela______________________ y se le ha otorgado un permiso especial (Special School Zone Request) por el corriente año escolar.

C. This Is to Certify That ____________________________________, for Whom Enrollment Is Requested in Fauquier County Public Schools, Does Not Reside Within the Boundaries of Fauquier County and Request for Out-of-County Tuition Status Has Been Granted for the Current School Year.

Certifico que ___________________________________a quien solicito se matricule en las Escuelas Públicas del Condado de Fauquier, no reside dentro de los límites del Condado de Fauquier y se le ha aprobado la solicitud para pagar una instrucción como un estudiante que vive fuera del condado, por el corriente año escolar.

D. This Is to Certify That _____________________________________, for Whom Enrollment Is Requested in Fauquier

County Public Schools, Does Not Presently Have a Fixed and Regular Nighttime Residence, Has Requested to Be Allowed to Enroll Pursuant to Policy, and Has Submitted a Student Residency Questionnaire.

Certifico que_____________________________________ a quien solicito se matricule en las Escuelas Públicas del Condado de Fauquier, actualmente no tiene una residencia permanente para pasar la noche y se solicita que se le permita matricular de acuerdo a los reglamentos establecidos y ha llenado y presentado un cuestionario de residencia (Student Residency Questionnaire).

Fauquier County Public Schools Shall Be Free to Each Person of School Age Who Resides Within the County of Fauquier. Tuition Is Regularly Charged to Other Persons Requesting Admission. A False Certification May Result in Legal Action to Recover Tuition Charges. Las personas que viven dentro de los confines del Condado de Fauquier tendrán derecho a asistir a las Escuelas Públicas del Condado en forma gratuita. Se cobran los gastos de instrucción a otras personas que soliciten ser admitidas. Si usted hace una declaración falsa, es posible que iniciemos una acción judicial en su contra para recobrar los gastos de instrucción.

____________________________________________________ __________________ Signature of Parent or Guardian/ Firma del padre, madre o tutor Date/Fecha Completed with the assistance of: / Nombre y firma de la persona que ayudó al Padre/Tutor a llenar el formulario: ____________________________________________________________ ____________ Signature/ Firma Date/Fecha

For Office Use Only

To the Principal: According to FCPS Policy, Two Proof of Residency Documents Are Required: At Least One at the Time of Initial Enrollment and a Second Within 30 Days of Enrollment. Please Check the Types of Proof Provided:

Housing Contract Rental Agreement/Letter from Owner or Landlord. (Must Be Notarized.)

Property Tax Bill Utility Bill (Cellular Telephone Bills Are Not Accepted.)

A Driver’s License Is Not Acceptable Proof of Residency. In Lieu of the Proof of Residency Documents, The Documents Required In Option D Above May Be Accepted. _____________________________________ __________________ Signature of Principal or Designee Date

An Inspection of Your Child’s Records Is Available upon Request. Los expedientes de su hijo(a) están a su disposición si desea revisarlos pero debe solicitarlo en la oficina de la escuela.

Distribution: Initial Enrollment Form Should Be Kept In Permanent Cumulative File. Do Not Purge.

7-2.3-F2REQUEST FOR OUT-OF-COUNTY TUITION STATUS

Name of student: ___________________________________________________ School Year: ________________________________

Present address of student: ___________________________________________

_________________________________________________________________

Name of parent/guardian: _____________________________________ Daytime phone: _____________________________ Are you a FCPS or FC employee: ___ Yes ___No (If you answer yes, form 7-2.2F1 MUST accompany this form) Present address: ____________________________________________________ Evening phone: _____________________________

_________________________________________________________________ Grade to attend: ____________________________

School Division previously attended: ___________________________________ School: ___________________________________

Under what circumstances did student leave? ________________________________________________________________________ __________________________________________________________________________________________

Is your child currently attending through a Special Request? Yes □ No □ If yes, first time applied: ____________________

Are you requesting that the tuition be waived? Yes □ No □

Does your child participate in any of the following programs: ___ Gifted ___ ESL ___Special Education Reason for special request: ______________________________________________________________________________________ _____________________________________________________________________________________________________________

________________________________________ ___________________________________ PARENT’S SIGNATURE DATE

NOTE: Students are subject to all policies, regulations, and guidelines of the School Division, including the Code of Conduct. REQUESTED SCHOOL OF ATTENDANCE SECTION It is the principal’s recommendation that this request be approved. Yes □ No □

Principal’s comments (if any): ___________________________________________________________________________________

____________________________________________________________________________________________________________

__________________________________________________ _________________________________________ PRINCIPAL’S SIGNATURE DATE

____________________________________________________________________________________________ CENTRAL OFFICE SECTION Out-of-County Request is approved for the school year indicated Yes □ No □ □ Tuition is charged in the amount of: _____________________ □ Tuition is waived □ Per School Board Policy 7-2.3

□ Other ___________________________________________________________ Central Office’s comments (if any): _____________________________________________________________________________ _________________________________________________________________________________________

______________________________________________ ______________________ Assistant Superintendent for Student & Special Education Services Date

When all signatures have been obtained, a copy of this form will be sent to the school, parent & Budget & Planning Office. Original form will be filed in the Supt’s Office. (Revised: 3/12)

7-2.3(A)F1FAUQUIER COUNTY PUBLIC SCHOOLS

Application for Part-Time Enrollment for Grades 9-12 School Year:___________________ Student’s Name:_____________________________________________________Date of Birth:________________________ Address:_____________________________________________________________________Grade Entering:_____________ Parent/Guardian:_____________________________Telephone No. (work)_________________ (home)__________________ Current Educational Placement: Educational Placement for Upcoming School Year: 1Home Schooled 1Home Schooled 1Religious Exemption 1Religious Exemption 1Private School 1Private School Specify:____________________ Specify:____________________ 1Charter School 1Charter School Specify:____________________ Specify:____________________ 1Other 1Other Specify:____________________ Specify:____________________ Classes (maximum of 2):

1) ___________________________________________________________________________ 2) ___________________________________________________________________________

(Attach assurance that all class prerequisites as outlined in the Program of Studies have been met including any assessment data and/or standardized testing.) First-Time Requests Must Include: 1Proof of Residency 1Birth Certificate and Social Security Number 1Immunization Records 1Expulsion/Long-Term Suspension Affidavit (JEC-F3) ____________________________________________ Signature of Parent/Guardian Date

FOR OFFICE USE ONLY

First Requested Class:_____________________________________________________ 1Recommended 1Not Recommended Justification:___________________________________________________________________________________________ ______________________________________________________________________________________________________ Second Requested Class:___________________________________________________ 1Recommended 1Not Recommended Justification:___________________________________________________________________________________________ _____________________________________________________________________________________________________ _ __________________________________________ Signature of Principal Date

FOR SUPERINTENDENT/SCHOOL BOARD ONLY 1 Approved 1Denied _________________________________________ __________________________________ _____________________ Name Title Date

A copy of the final recommendation should be duplicated and sent to the school and parent. One copy will be retained in the Superintendent’s office.

AFFIDAVIT

PENDING CERTIFIED COPY OF BIRTH CERTIFICATE

________________________________________, answers to the best of his/her personal knowledge, the following

questions in his/her own handwriting on this page, asked by duly authorized officials of the Fauquier County Public

Schools Division concerning a pupil’s identity and age requesting enrollment as a pupil within the Division in

accordance with Section 22.1-3.1 of the Code of Virginia.

1. What is your name? ________________________________________________________________________

2. Have you been advised by an official of the Division, and do you understand that you are required to answer the

questions contained in this Affidavit as a condition to your enrollment and admission of a pupil into the

Division because of your inability to supply the Division with a certified copy of the pupil’s birth record? _____

3. Do you understand that giving a false or otherwise untrue answer to any of the questions in this Affidavit could

result in a criminal charge being brought against you? _____

4. Do you understand that when a question in this Affidavit asks if you have knowledge of or if you know of an

instance or situation, it means that you are expected to relate any knowledge you may have about the incident,

whether it be personal knowledge or information received from other people, and to relate the source of your

knowledge and information? _____

5. What is the full name of the pupil you wish to enroll in this Division? _________________________________

6. What is the age, date, and place of birth of the pupil being enrolled in this Division?

_________________________________________________________________________________________

7. Who are the parents, parents by legal adoption, or person serving in loco parentis and responsible for the care of

the pupil desired to be enrolled? _______________________________________________________________

8. Do you have legal custody imposed by a court order or have you been designated court-appointed guardian for

the pupil desired to be enrolled? ________________ What court entered such order and what type of case was

it (i.e., custody hearing, etc.? __________________________________________________________________

9. Why are you unable to present a certified copy of the birth records of the enrolling student?

_________________________________________________________________________________________

10. What documentary (written) proof can be or is offered of the pupil’s identity and age? (Attach same hereto.)

________________________________________________________________________________________

11. To the best of your knowledge, has this pupil ever been reported to any law enforcement agency as a missing

child? _____ If the response to question #11 is “yes”, identify by name and address the law enforcement

agency and date of report. ___________________________________________________________________

________________________________________

AFFIANT SIGNATURE

7-2.3(A)F2

REV. 6/1/2012

NOTARIAL STATEMENT:

I HEREBY CERTIFY THAT ON THIS _____DAY OF __________, ________ IN FAUQUIER COUNTY,

VIRGINIA, ________________________________AND __________________________, PARENT(S)/LEGAL

CUSTODIAN(S) OF THE ABOVE NAMED STUDENT, PERSONALLYAPPEARED BEFORE ME AND

ACKNOWLEDGED THAT THE FOREGOIONG FACTS ARE TRUE AND CORRECT TO THE BEST OF

HIS/HER KNOWLEDGE, INFORMATION AND BELIEF.

NOTARY PUBLIC: _______________________________ NOTARY REGISTRATION NUMBER: ______________

MY COMMISSION EXPIRES: ______________________

AFFIDAVIT

PENDING CERTIFIED COPY OF BIRTH CERTIFICATE

§ 22.1-3.1 Birth certificates required upon admission; required notice to the local law-enforcement agency.

A. Except as otherwise provided in this subsection, no pupil shall be admitted for the first time to any

public school in any school division in this Commonwealth unless the person enrolling the pupil shall

present, upon admission, a certified copy of the pupil’s birth record. The principal or his designee

shall record the official state birth number from the pupil’s birth record into the pupil’s permanent

school record and may retain a copy in the pupil’s permanent school record. If a certified copy of the

pupil’s birth record cannot be obtained, the person so enrolling the pupil shall submit an affidavit

setting forth the pupil’s age and explaining the inability to present a certified copy of the birth record.

If the school division cannot ascertain a child’s age because of the lack of a birth certificate, the child

shall nonetheless be admitted into the public schools if the division superintendent determines that the

person submitting the affidavit presents information sufficient to estimate with reasonable certainty the

age of such child.

However, if the student seeking enrollment is a homeless child or youth as defined in § 22.1-3, the

school shall immediately enroll such student, even if such student is unable to produce the records

required for enrollment and shall immediate contact the school last attended by the student to obtain

relevant academic and other records, and shall comply with the provisions of the federal McKinney-

Vento Homeless Education Assistance Improvements Act of 2001, as amended (42 U.S.C. § 11431 et

seq.), including immediately referring the parent of the student or the youth to the local school division

liaison, as described in the federal Act, who shall assist in obtaining the necessary records for

enrollment.

B. Upon failure of any person enrolling a pupil to present a certified copy of the pupil’s birth record, the

principal of the school in which the pupil is being enrolled or his designee shall immediately notify the

local law-enforcement agency. The notice to the local law-enforcement agency shall include copies of

the submitted proof of the pupil’s identify and age and the affidavit explaining the inability to produce

a certified copy of the birth record.

C. Within fourteen (14) days after enrolling a transferred pupil, the principal of the school in which the

pupil has been enrolled or his designee shall request that the principal or his designee of the school in

which the pupil was previously enrolled submit documentation that a certified copy of the pupil’s birth

record was presented upon the pupil’s enrollment.

D. Principals and their designees shall be immune from any civil or criminal liability in connection with

any notice to a local law-enforcement agency of a pupil lacking a birth certificate or failure to give

such notice as required by this section.

(1990, c.295; 1991, c. 523; 2004, c 500; 2007, c. 49.)

7-2.3(A)F2 REV. 6/1/2012

7-2.3 (A)F3 REV. 6/1/2012

FAUQUIER COUNTY PUBLIC SCHOOLS CRIMINAL CONVICTION, JUVENILE DELINQUENCY ADJUDICATION,

AND HISTORY OF EXPULSION AFFIRMATION

1

Section 22.1-3.2 of the Code of Virginia requires that parents/guardians provide upon registration of students in public schools:

1. “A sworn statement or affirmation indicating whether the student has been expelled from school attendance at a private school or in a public school division of the Commonwealth or in another state for an offense in violation of school board policies relating to weapons, alcohol or drugs, or for the willful infliction of injury to another person[et seq].

2. A sworn statement or affirmation indicating whether the student has been found

guilty of or adjudicated delinquent for any offense listed in subsection G of § 16.1-260 or any substantially similar offense under the laws of any state, the District of Columbia, or the United States or its territories[et seq].

C. ANY PERSON MAKING A MATERIALLY FALSE STATEMENT OR AFFIRMATION

SHALL BE GUILTY UPON CONVICTION OF A CLASS 3 MISDEMEANOR.” These offenses include but may not be limited to: • A firearm offense • Arson and related crimes • Homicide • Burglary and related offenses • Felonious assault and bodily wounding • Robbery • Criminal sexual assault • Prohibited street gang participation • Manufacture, sale, gift, distribution or

possession of Schedule I or II controlled substances

• Recruitment of other juveniles for criminal street gang activity

• Manufacture, sale or distribution of marijuana

• Prohibited street gang activity

Student Name: __________________________________ Date of Birth: _______________ Parent/Legal Guardian Affirmation:

I affirm that the above student has not been expelled from school attendance at a private school or in a public school division of the Commonwealth or in another state or the District of Columbia for an offense listed above or any substantially similar offense.

I affirm that the above student has not been found guilty of or adjudicated delinquent for an offense listed above or any substantially similar offense under the laws of any state, the District of Columbia, or the United States or its territories.

I affirm that the above student has been expelled from school attendance at a private school or in a public school division of the Commonwealth or in another state or the District of Columbia for an offense listed above or any substantially similar offense. Name and Location of Expelling School/Division: __________________________________ Date of Expulsion: ______________ Reason for Expulsion: _________________________

I affirm that the above student has been found guilty of or adjudicated delinquent for an offense listed above or any substantially similar offense under the laws of any state, the District of Columbia, or the United States or its territories. ______________________ ______________ __________________________________ Type of Offense Date of Offense Jurisdiction Where Offense Occurred

(PARENT SIGNATURE AND NOTARY STATEMENT ON REVERSE - PAGE 2)

7-2.3 (A)F3 REV. 6/1/2012

FAUQUIER COUNTY PUBLIC SCHOOLS CRIMINAL CONVICTION, JUVENILE DELINQUENCY ADJUDICATION,

AND HISTORY OF EXPULSION AFFIRMATION

2

PARENT/GUARDIAN SIGNATURE DATE PRINTED PARENT/GUARDIAN NAME ____________________________ ________ ________________________________ NOTARIAL STATEMENT: I HEREBY CERTIFY THAT ON THIS _______ DAY OF ________________, _________, IN FAUQUIER (DAY) (MONTH) (YEAR) COUNTY, VIRGINIA, ________________________ AND ___________________________, PARENT(S)/LEGAL (PARENT(S)/LEGAL GUARDIAN(S) NAMES(S) CUSTODIAN(S) OF THE ABOVE NAMED STUDENT, PERSONALLY APPEARED BEFORE ME AND ACKNOWLEDGED THAT THE FOREGOING FACTS ARE TRUE AND CORRECT TO THE BEST OF HIS/HER KNOWLEDGE, INFORMATION AND BELIEF. NOTARY PUBLIC: ___________________________ NOTARY REGISTRATION NUMBER: _______________ MY COMMISSION EXPIRES: __________________________

_______________________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________

COMMONWEALTH OF VIRGINIA SCHOOL ENTRANCE HEALTH FORM

Health Information Form/Comprehensive Physical Examination Report/Certification of Immunization

Part I – HEALTH INFORMATION FORM

State law (Ref. Code of Virginia § 22.1-270) requires that your child is immunized and receives a comprehensive physical examination before entering public kindergarten or elementary school. The parent or guardian completes this page (Part I) of the form. The Medical Provider completes Part II and Part III of the

form. This form must be completed no longer than one year before your child’s entry into school.

Name of School: ____________________________________________________________________________________ Current Grade: _______________________

Student’s Name: _________________________________________________________________________________________________________________________

Last First Middle Student’s Date of Birth: _____/_____/_______ Sex: _______ State or Country of Birth: ________________________ Main Language Spoken: ______________

Student’s Address: ______________________________________________________ City: ____________________ State: _______________ Zip: _______________

Name of Parent or Legal Guardian 1: ____________________________________________ Phone: ______-______-________ Work or Cell: _____-_____-______

Name of Parent or Legal Guardian 2: ____________________________________________ Phone: ______-______-________ Work or Cell: _____-_____-______

Emergency Contact: __________________________________________________________ Phone: ______-______-________ Work or Cell: _____-_____-______

Condition Yes Comments Condition Yes Comments

Allergies (food, insects, drugs, latex) Diabetes

Allergies (seasonal) Head injury, concussions

Asthma or breathing problems Hearing problems or deafness

Attention-Deficit/Hyperactivity Disorder Heart problems

Behavioral problems Lead poisoning

Developmental problems Muscle problems

Bladder problem Seizures

Bleeding problem Sickle Cell Disease (not trait)

Bowel problem Speech problems

Cerebral Palsy Spinal injury

Cystic fibrosis Surgery

Dental problems Vision problems

Describe any other important health-related information about your child (for example; feeding tube, hospitalizations, oxygen support, hearing aid, dental appliance,

etc.):__________________________________________________________________________________________________________________________________

List all prescription, over-the-counter, and herbal medications your child takes regularly:

Check here if you want to discuss confidential information with the school nurse or other school authority. Yes No

Please provide the following information:

Name Phone Date of Last Appointment

Pediatrician/primary care provider

Specialist

Dentist

Case Worker (if applicable)

Child’s Health Insurance: ____ None ____ FAMIS Plus (Medicaid) _____ FAMIS _____ Private/Commercial/Employer sponsored

I, ______________________________________ (do___) (do not___) authorize my child’s health care provider and designated provider of health care in the

school setting to discuss my child’s health concerns and/or exchange information pertaining to this form. This authorization will be in place until or unless you

withdraw it. You may withdraw your authorization at any time by contacting your child’s school. When information is released from your child’s record,

documentation of the disclosure is maintained in your child’s health or scholastic record.

Signature of Parent or Legal Guardian: ______________________________________________________________________Date: _______/________/ __________

Signature of person completing this form: ____________________________________________________________________Date:_______/________/___________

Signature of Interpreter: __________________________________________________________________________________Date: ______/_____/_______

MCH 213G reviewed 03/2014 1

7-2.3(B)F1

I I

Certification of Immunization 11/06

Other 1 2 3 4 5

* Required vaccine

COMMONWEALTH OF VIRGINIA

SCHOOL ENTRANCE HEALTH FORM

Part II - Certification of Immunization

Section I

To be completed by a physician or his designee, registered nurse, or health department official. See Section II for conditional enrollment and exemptions.

A copy of the immunization record signed or stamped by a physician or designee, registered nurse, or health department

official indicating the dates of administration including month, day, and year of the required vaccines shall be acceptable

in lieu of recording these dates on this form as long as the record is attached to this form.

Only vaccines marked with an asterisk are currently required for school entry. Form must be signed and dated by the

Medical Provider or Health Department Official in the appropriate box.

Student’s Name: Date of Birth: |____|____|____| Last First Middle Mo. Day Yr.

IMMUNIZATION RECORD COMPLETE DATES (month, day, year) OF VACCINE DOSES GIVEN

*Diphtheria, Tetanus, Pertussis (DTP, DTaP) 1 2 3 4 5

*Diphtheria, Tetanus (DT) or Td (given after 7

years of age) 1 2 3 4 5

*Tdap booster (6th grade entry) 1

*Poliomyelitis (IPV, OPV) 1 2 3 4

*Haemophilus influenzae Type b

(Hib conjugate) *only for children <60 months of age

1 2 3 4

*Pneumococcal (PCV conjugate) *only for children <60 months of age

1 2 3 4

Measles, Mumps, Rubella (MMR vaccine) 1 2

*Measles (Rubeola) 1 2 Serological Confirmation of Measles Immunity:

*Rubella 1 Serological Confirmation of Rubella Immunity:

*Mumps 1 2

*Hepatitis B Vaccine (HBV)

Merck adult formulation used 1 2 3

*Varicella Vaccine 1 2 Date of Varicella Disease OR Serological Confirmation of Varicella

Immunity:

Hepatitis A Vaccine 1 2

Meningococcal Vaccine 1

Human Papillomavirus Vaccine 1 2 3

Other 1 2 3 4 5

Other 1 2 3 4 5

I certify that this child is ADEQUATELY OR AGE APPROPRIATELY IMMUNIZED in accordance with the MINIMUM requirements for attending school, child

care or preschool prescribed by the State Board of Health’s Regulations for the Immunization of School Children (Reference Section III).

Signature of Medical Provider or Health Department Official: Date (Mo., Day, Yr.):___/___/____


__________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________

Student’s Name: Date of Birth: |____ |_ ___|___ _|

Section II Conditional Enrollment and Exemptions

Complete the medical exemption or conditional enrollment section as appropriate to include signature and date.

MEDICAL EXEMPTION: As specified in the Code of Virginia § 22.1-271.2, C (ii), I certify that administration of the vaccine(s) designated below would be detrimental to this student’s health. The vaccine(s) is (are) specifically contraindicated because (please specify):

_______________________________________________________________________________________________________________________.

DTP/DTaP/Tdap:[ ]; DT/Td:[ ]; OPV/IPV:[ ]; Hib:[ ]; Pneum:[ ]; Measles:[ ]; Rubella:[ ]; Mumps:[ ]; HBV:[ ]; Varicella:[ ]

This contraindication is permanent: [ ], or temporary [ ] and expected to preclude immunizations until: Date (Mo., Day, Yr.): |___|___|___|.

Signature of Medical Provider or Health Department Official: Date (Mo., Day, Yr.):|___|___|___|

RELIGIOUS EXEMPTION: The Code of Virginia allows a child an exemption from receiving immunizations required for school attendance if the student or the student’s parent/guardian submits an affidavit to the school’s admitting official stating that the administration of immunizing agents conflicts with the student’s religious

tenets or practices. Any student entering school must submit this affidavit on a CERTIFICATE OF RELIGIOUS EXEMPTION (Form CRE-1), which may be obtained at

any local health department, school division superintendent’s office or local department of social services. Ref. Code of Virginia § 22.1-271.2, C (i).

CONDITIONAL ENROLLMENT: As specified in the Code of Virginia § 22.1-271.2, B, I certify that this child has received at least one dose of each of the vaccines

required by the State Board of Health for attending school and that this child has a plan for the completion of his/her requirements within the next 90 calendar days. Next

immunization due on __________________.

Signature of Medical Provider or Health Department Official: Date (Mo., Day, Yr.):|___|___|___|

Section III

Requirements

For Minimum Immunization Requirements for Entry into School and

Day Care, consult the Division of Immunization web site at

http://www.vdh.virginia.gov/epidemiology/immunization

Children shall be immunized in accordance with the Immunization Schedule developed and published by

the Centers for Disease Control (CDC), Advisory Committee on Immunization Practices (ACIP), the

American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP),

otherwise known as ACIP recommendations (Ref. Code of Virginia § 32.1-46(a)).

(Requirements are subject to change.)

Certification of Immunization 03/2014


http://www.vdh.virginia.gov/epidemiology/immunization

I I I I I

I I I I I I I II'--------------I --

Part III -- COMPREHENSIVE PHYSICAL EXAMINATION REPORT

A qualified licensed physician, nurse practitioner, or physician assistant must complete Part III. The exam must be done no longer than one year before entry

into kindergarten or elementary school (Ref. Code of Virginia § 22.1-270). Instructions for completing this form can be found at www.vahealth.org/schoolhealth.

Student’s Name: _______________________________________________ Date of Birth: _____/_____/__________ Sex: □ M □ F

Hea

lth

Ass

essm

ent

Date of Assessment: _____/_____/_______

Weight: ________lbs. Height: _______ ft. ______ in.

Body Mass Index (BMI): ___________ BP____________

Age / gender appropriate history completed

Anticipatory guidance provided

Physical Examination

1 = Within normal 2 = Abnormal finding 3 = Referred for evaluation or treatment

1 2 3 1 2 3 1 2 3

HEENT □ □ □ Neurological □ □ □ Skin □ □ □

Lungs □ □ □ Abdomen □ □ □ Genital □ □ □

Heart □ □ □ Extremities □ □ □ Urinary □ □ □

TB Screening: □ No risk for TB infection identified □ No symptoms compatible with active TB disease

□ Risk for TB infection or symptoms identified

Test for TB Infection: TST IGRA Date:_______ TST Reading _____mm TST/IGRA Result: □ Positive □ Negative

CXR required if positive test for TB infection or TB symptoms. CXR Date: __________ □ Normal □ Abnormal

EPSDT Screens Required for Head Start – include specific results and date:

Blood Lead:___________________________________________ Hct/Hgb ____________________________________________

Dev

elo

pm

enta

l

Scr

een

Assessed for: Assessment Method: Within normal Concern identified: Referred for Evaluation

Emotional/Social

Problem Solving

Language/Communication

Fine Motor Skills

Gross Motor Skills

Hea

rin

g

Scr

een

Screened at 20dB: Indicate Pass (P) or Refer (R) in each box.

1000 2000 4000

R

L

Screened by OAE (Otoacoustic Emissions): □ Pass □ Refer

□ Referred to Audiologist/ENT □ Unable to test – needs rescreen

□ Permanent Hearing Loss Previously identified: ___Left ___Right

□ Hearing aid or other assistive device

With Corrective Lenses (check if yes)

Den

tal

Scr

een Problem Identified: Referred for treatment

No Problem: Referred for prevention

No Referral: Already receiving dental care

Vis

ion

Scr

een

Stereopsis Pass Fail Not tested

Distance Both R L Test used:

20/ 20/ 20/

Pass Referred to eye doctor Unable to test – needs rescreen

Recom

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Summary of Findings (check one):

□ Well child; no conditions identified of concern to school program activities

□ Conditions identified that are important to schooling or physical activity (complete sections below and/or explain here): _______________________

_____________________________________________________________________________________________________________________________

___ Allergy □ food: _____________________ □ insect: _____________________ □ medicine: _____________________ □ other: _________________

Type of allergic reaction: □ anaphylaxis □ local reaction Response required: □ none □ epinephrine auto-injector □ other: ________________

___Individualized Health Care Plan needed (e.g., asthma, diabetes, seizure disorder, severe allergy, etc)

___ Restricted Activity Specify: _________________________________________________________________________________________________

___ Developmental Evaluation □ Has IEP □ Further evaluation needed for: ___________________________________________________________

___ Medication. Child takes medicine for specific health condition(s). □ Medication must be given and/or available at school.

___ Special Diet Specify: ______________________________________________________________________________________________________

___ Special Needs Specify: ______________________________________________________________________________________________________

Other Comments: _____________________________________________________________________________________________________________

Health Care Professional’s Certification (Write legibly or stamp) □ By checking this box, I certify with an electronic signature that all of

the information entered above is accurate (enter name and date on signature and date lines below).

Name: _____________________________________ Signature: ________________________________________ Date: ____/_____/______

Practice/Clinic Name: __________________________________________ Address: ____________________________________________________________

Phone: _______-_______-____________________ Fax: _______-_______-______________ Email: ______________________________________________


www.vahealth.org/schoolhealth

7-2.3(B)F2

COMMONWEALTH OF VIRGINIA CERTIFICATE OF RELIGIOUS EXEMPTION

Name of Student Date of Birth Student I.D. Number

The administration of immunizing agents conflicts with the above-named student’s/my religious tenets or practices. I understand that, in the occurrence of an outbreak, potential epidemic or epidemic of a vaccine-preventable disease in my/my child’s school, the State Health Commissioner may order my/my child’s exclusion from school, for my/my child’s own protection, until the danger has passed.

Signature of parent/guardian/student Date

AFFIRMATION

In the County/City of ___________________________, State of _________________________________; to wit: This _____ day of __________, _____ personally appeared before me, a notary public in and for the County/City and State aforesaid, ____________________________________________, who did certify that there are no willful misrepresentations in, or falsifications of, the above statements. _____________________________________________ Notary Public My commission expires: _________________________