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BLOOMINGDALE ELEMENTARY SCHOOLS
Mr. Patrick R Haugens Principal
Mrs. Stacy Johnston Assistant Principal
Erickson Elementary School 277 Springfield Drive
Bloomingdale, IL 60108 Phone: 630-529-2223
Fax: 630-893-9849 www.sd13.org
Developing Actively Involved Learners and Responsible Citizens In Partnership with the Community
February 1, 2018
Dear Parents,
It is time to register your kindergarten student for the 2018-2019 school year. Eligible students must be 5
years of age on or before September 1, 2018.
Kindergarten Registration will take place from February 20th through February 23rd in the Erickson
Elementary office. The Erickson office will be open until 6:00pm on Wednesday, February 21st
to assist with registration.
All parents must provide a certified birth certificate for your child with registration material. The
school will make a copy of the birth certificate and return the original to you. In addition, parents will
need to provide documents to prove residency.
Completing these forms at home will reduce the amount of time it will take you to complete the
registration process. Please review the registration checklist to ensure all the necessary documents are
completed.
We are very excited to welcome your child to the Erickson family and look forward to seeing them
Soar like an Eagle.
If you have any questions, please contact the building principal by phone 630-529-2223 or email
Sincerely,
Patrick Haugens
Principal
School Fee Payment Procedures Beginning June 1st, School Fees will be assigned to students and will appear in their PushCoinaccount. See below for a breakdown of the required and optional fees. Please note the “early-bird” discount offered for payment of required fees prior to July 1st.
REQUIRED KINDERGARTEN FEES for 2018-2019
2018-2019 Fee if paid after July 1st Discounted Fee if paid by June 30th
Registration $60.00 $50.00
Technology Fee $60.00 $50.00
Optional Kindergarten Fees for 2018-2019
Milk $34.00
Round Trip Bus Transportation $380.00
where applicable
One-Way Bus Transportation
PTO Membership $15.00 for one child
$25.00 for two or more children
Bloomingdale SD13 Education Foundation Contribution
Any donation amount is welcomed
and appreciated
$ ______________
Beginning June 1st, if you choose to pay by paper check – instead of using PushCoin online payment services - please know that you will need to either mail or bring this form, along with your check, to the main office of your child’s school. No Cash will be accepted.
In-person payment, follow these steps: ● Indicate which fees you are paying for in the chart(s) above by checking the ’s
● Enter the total cost here _______________________________● Make your check payable to Bloomingdale SD13● Enter yours and your student’s name below● Sign and date below● Bring or mail form and paper check to your school’s main office
Printed Parent Name: ___________________________________________________________________________
Printed Kindergarten Student’s Name: ________________________________________________________
Parent Signature: ________________________________________________________________________________
Date: ______________________________________________________________________________________________
*
* 2018-2019 Fees are subject to Board Approval
$190.00 where applicable
School Fee Payment Procedures [These instructions may also be found by clicking the Parent link on the SD13.org website]
Kindergarten parents will be asked to pay school fees (see fee chart on back) beginning June 1st of the year their student will be attending SD13 schools. After completing the required registration forms and
submitting the necessary proof of residency documentation, a student record will be created for the new Kindergarten student. Once the record has been created in the SD13 student information system, the kindergarten student will be considered enrolled in the district and fees will be assigned. Kindergarten parents will receive an email on or shortly before June 1st informing them of their school fee obligations, along with instructions on how to pay these fees online.
Bloomingdale SD13 uses PushCoin, an online service, for parents to pay for school fees. PushCoin.com is a mobile-friendly website, so any Internet enabled device, including a smartphone or tablet, may be used to pay for school fees. The site will adjust to your device’s screen and act like an App. You might consider bookmarking the site: https://www.pushcoin.com for quick access.
SIGN UP … Follow these steps to create a PushCoin account:
1. Go to www.pushcoin.com. Use the latest internet browsers as they are the most secure.
2. Either click on I don't have an account and fill out the form using a valid email address OR use an acceleratedsign up by clicking on the Facebook, Gmail, LinkedIn or Hotmail links.
LOOK FOR … an email on or before June 1st that includes your student’s PushCoin Authorization code:
3. To add your student to your PushCoin account click the Add User button (found in the upperright corner of your PushCoin Users home screen).Enter the unique PushCoin Registration Code which has been sent from [email protected] to theemail address that you have provided to SD13 when enrollingyour student.If you don’t have the unique code, click Request StudentAccess and complete the online form.
4. Once a valid Authorization code is entered, informationabout the student will appear on the screen. Verify theinformation is correct and click Confirm.
If you have multiple students, repeat steps 3-4 for each of your students.
PAYING FOR SCHOOL FEES
● When school fees appear on your student’s PushCoin account you will see a red negative balance under FeesBalance. You can review the assigned fees under School Fees tab. To pay for school fees, click Pay Fees.
● You may also use your PushCoin account to purchase optional items, such as milk, transportation, organizationdonations, etc. Optional items are listed below your required fees on your PushCoin account and on the back ofthis document.
FUNDING
Set up your payment method by clicking on Accounts and then click on Add Account: ● Electronic check (eCheck): The eCheck funding option is always FREE for parents and all school districts
working with PushCoin. Your bank routing number and bank account number will be required to use aneCheck for paying school fees.
● Credit Card or Debit Card (Visa, MasterCard, Discover): There is an additional fee of 2.79% + $0.25 pertransaction to use credit or debit cards. This fee is establised by the card processor (Not PushCoin or SD13).SD13 does not make any profit on this fee. The fee will be in addition to the original transaction amount. Youwill be able to see the total cost before submitting the transaction. If you are using a credit or debit card topay for school fees or add funds to your student's wallet, you will need to enter the CVV number that's on theback of the card.
If you have questions about your PushCoin account, contact your school or PushCoin via email at [email protected].
BLOOMINGDALE SCHOOL DISTRICT 13
2018-2019 KINDERGARTEN REGISTRATION CHECKLIST
*Please return this sheet with completed documents to the school office.
Student’s Legal Name ________________________________________________________________
School _____________________________________________________________________________
Proof of Residency Three documents are required as shown on the “Proof of Residency” form. A child cannot start until the residency requirement is complete.
Certified Birth Certificate. Please contact the appropriate county office vital records department to obtain the official birth record for their child. Phone numbers for surrounding counties are: DuPage County – 630-682-7400; Cook County – 866.252.8974; Kane County – 630-232-5950; Lake County – 847-377-2400. Also you can go to a local Currency Exchange to obtain a birth certificate.
Six registration forms:
Proof of Residency Sheet Student Registration & Emergency Consent Form Ethnicity/Race Letter and Form Class Placement Background Information Sheet Language Survey Military Letter
Student fees. Please see the attached fee schedule for payment amount along with on-line/check payment instructions.
Optional Forms.
Affidavit
Fee Waiver
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Category 2A: Only complete if a Category 2 document cannot be provided (If Applicable)
Category 3: Provide one of the following documents:
Category 2: Provide one of the following documents:
BLOOMINGDALE SCHOOL DISTRICT 13 2018-2019 PROOF OF RESIDENCY FORM
(Students must be District residents as of the First Day of School)
ALL DOCUMENTS ACCEPTED FOR PROOF OF RESIDENCY MUST HAVE THE SAME ADDRESS:
Illinois Driver’s License Illinois State ID Other Photo ID
Current mortgage statement or closing statement from bank or lender Real estate tax bill from current school year Current lease showing the name, address and phone number of landlord
Notarized Affidavit of Residency Form (See Attached)
Current electric, water, gas or cable/internet bill in your name Valid Illinois vehicle registration Current pay stub from your employer Current public aid card or document from DHS or DCFS that includes your name▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪This proof of residency form is to attest that the child is not enrolling in the District solely for school purposes and is living on a permanent basis with the person having complete custody and control. Registration of a student who is not a resident is a fraudulent act. Any student found to have been fraudulently registered will be dropped from the attendance rolls immediately. Parents or guardians making a fraudulent registration will be subject to the payment of retroactive tuition charged for non-resident students, not to exceed 110% of the per capita cost. A person who knowingly or willfully presents the District with any false information regarding the residency of a pupil for the purpose of enabling that pupil to attend any school in the District shall have committed a Class C misdemeanor and shall be prosecuted by the District. The District will employee an agency to conducted an investigation if fraud is suspected.
I certify that I understand the residency requirements and that I know the penalty for fraudulent registration.
Parent/Guardian Signature Date
Parent Guardian Address Telephone
Name of Student Grade School
Name of Student Grade School
Name of Student Grade School
Name of Student Grade School
Category 1: Provide one of the following documents:
BLOOMINGDALE SCHOOL DISTRICT 13 2018‐2019 NEW STUDENT
AFFIDAVIT OF RESIDENCY FORMIF APPLICABLE (If box 2A was checked)
(Students must be District residents as of the First Day of School)
*The Bloomingdale School District 13 resident/homeowner must also submit documents from category I andcategory III. The parent or guardian must also submit an IL Driver’s License, IL State ID or other photo ID with theBloomingdale School District 13 address on it.
I, ________________________________________, the parent or legal guardian of (Printed Name of Parent/Legal Guardian)
__________________________________________, being first duly sworn, state on oath that (Printed Name of Student or Students)
the named student(s) above is/are under my custody, but we will be residing with
_______________________________________ at ___________________________________ (Printed Name of Resident) (Address)
for the 2018‐2019 school year. The reason that the student must reside at this address is _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________
▪ ▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪ This affidavit of residency form is to attest that the above child is not enrolling in the District solely forschool purposes and is living on a permanent basis with the person having complete custody and control.Registration of a student who is not a resident is a fraudulent act. Any student found to have been fraudulentlyregistered will be dropped from the attendance rolls immediately. Parents or guardians making afraudulent registration will be subject to the payment of retroactive tuition charged for non‐resident students,not to exceed 110% of the per capita cost. A person who knowingly or willfully presents the District with anyfalse information regarding the residency of a pupil for the purpose of enabling that pupil to attend anyschool in the District shall have committed a Class C misdemeanor and shall be prosecuted by the District.The District will employee an agency to conducted an investigation if fraud is suspected.
I certify that I understand the residency requirements and that I know the penalty for fraudulent registration.
SUBSCRIBED AND SWORN TO _________________________ before me this _________ day Parent Signatureof _____________, 20______
_________________________ Telephone
__________________________ Notary Public _________________________
Owner of Property Signature (Stamp)
_________________________Telephone
Developing Actively Involved Learners. Well-Rounded Students. and Responsible Citizens in Partnership with the Community
Dear Parent or Guardian:
Re: Illinois State Board of Education New U.S. Department of Education Race and Ethnicity Data Standards
In fall 2007, the U.S. Department of Education issued new guidance on the collection and reporting of race and ethnicity data for public school students and staff. The guidance implements new federal race and ethnicity categories that were developed to obtain a more accurate picture of the nation's diversity. The new data collection process requires respondents to answer a two-part question, indicating ethnicity first and then one or more of five races. (In the past, individuals were allowed to choose only one race or ethnicity category.)
The Illinois State Board of Education (ISBE) will use the new categories for data to be reported for the 2018·2019 school year. This requires school districts to re-identify race and ethnicity for all students and the identification is to be done by parents or guardians. If a student's parents or guardians decline to indicate race and/or ethnicity, observer identification by school district staff is required.
The new race and ethnicity data will be used in the same manner as previously collected data, e.g. in reporting and analyzing test results by race and ethnicity. The information will not be used to check immigration status, and the confidentiality of individual student information will be protected.
On the back of this letter is the form that parents or guardians need to complete to identify race and ethnicity for their children. Please complete one form per child, and be sure to answer both parts of the two-part question. School district staff is required to provide any missing information by observer identification. Please return the completed form with your child's school registration form.
Thank you for your cooperation in providing the needed data. Please direct any questions you may have to my office at the telephone number and address listed above.
Sincerely,
John Reiniche, CSBO Director of Finance
Bloomingdale School District 13 164 Euclid Avenue
Bloomingdale, Illinois 60108-2604
John T. Reiniche Director of Finance
630-671-5035
Jan Konchar Administrative Assistant
/Bookkeeper 630-671-5031
Geri Zanoni Payroll
630-671-5032
Fax 630-893-1818
Illinois State Board of Education New U.S. Department of Education Race and Ethnicity Data Standards
Student’s Name:
INSTRUCTIONS: This form is to be filled out by the student’s parents or guardians, and both questions must be answered. Part A asks about the student’s ethnicity and Part B asks about the student’s race. If you decline to respond to either question, the school district is required to provide the missing information by observer identification.
Part A. Is this student Hispanic/Latino? (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.) Choose only one.
No, not Hispanic/Latino
Yes, Hispanic/Latino
The question above is about ethnicity, not race. No matter which answer you selected, continue and respond to the question below by marking one or more boxes to indicate what you consider this student’s race to be.
Part B. What is the student’s race? Choose one or more.
American Indian or Alaska Native (A person having origins in any of the original peoples ofNorth and South America, including Central America, and who maintains tribal affiliation orcommunity attachment.)
Asian (A person having origins in any of the original peoples of the Far East, SoutheastAsia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan,Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.)
Black or African American (A person having origins in any of the black racial groups ofAfrica.)
Native Hawaiian or Other Pacific Islander (A person having origins in any of the originalpeoples of Hawaii, Guam, Samoa, or other Pacific Islands.)
White (A person having origins in any of the original peoples of Europe, the Middle East, orNorth Africa.)
Note: Data collected on this form must be maintained by the school district for three years. However, when there is litigation, a claim, an audit, or another action involving this record, the original responses must be retained until the completion of the action.
Illinois State Board of Education, Division of Data Analysis and Progress Reporting December 2009
CLASS PLACEMENT BACKGROUND INFORMATION SHEET
Student's Name Date of Birth________________
Date School _____________ Last Grade Completed ___________
Yes No
Was the student last enrolled in a regular education classroom? If no, please list type of classroom:
Was the student ever enrolled in a special education program? If yes,
Was it a full day class?
Was it a partial day class?
Was it for Learning Disabilities?
Was it for Speech?
Was it another type of class?
Does the student have special needs in:
Learning?
Communication?
Physical?
Health?
Social?
Has the student been in a gifted and/or talent program?
Has the student been in a Title I Program?
Has the student been in a Bilingual Education Program?
01/2017
STUDENT LANGUAGE SURVEY
Indicate the best answer to each question:
1. Was English the first language the student learned? Yes No
2. If no is the answer to question # 1. What was the first language learned bythe child? ______________________________
3. Can the student speak a language other than English? Yes No
4. Code number of language spoken in the home, if other than English. ______
5. What language is spoken in the home? ________________________________
6. What language do you most often use to speak to your child?_________________________________
7. What language does the student use most often when speaking to parents?(Specific language spoken)___________________________________________
8. What language does the child use most often with friends outside the home?_____________________________________
9. Please circle the number that corresponds with your appropriate race.
1. American Indian or Alaska Native2. Asian3. Black or African American4. Native Hawaiian or Other Pacific Island5. White
10. Can an adult family member or extended family member speak English?______________________ If yes, who can speak English? _______________
Can they read English? ___________________
Prior Schooling:
11. When did your child first enter school in the USA? In what state?_____________________________________
12. Was the student enrolled in a bi-lingual or ESL program? Yes No
(over)
13. If #11 is yes, give the name and location of the school where the studentreceived the bi-lingual instruction.
14. Did the student exit the program? ____________ Exit Date: ______________
15. What country was the student born in?
16. What is the student’s native country?
17. How many years has the student been in the United States?
18. What is the father’s native country?
19. What is the mother’s native country?
Parent/Guardian Signature
3/2010
Developing Actively Involved Learners. Well-Rounded Students. and Responsible Citizens in Partnership with the Community
Dear Parent or Guardian
Pursuant to Public Act 97-505, school districts must now report as aggregated data to the Illinois State Board of Education, enrollment information concerning parents' or guardians' military service.
Please take a few moments to answer these voluntary questions. This information will help identify Illinois military families. Your participation will help schools get U.S. Department of Defense assistance for children struggling with their parent's or guardian's military deployment.
Please return completed form to your child(ren)'s school. Thank you
Sincerely,
John Reiniche, CSBO Director of Finance
Name(s) of child(ren) School Attending
Does the Child(ren)’s parent or guardian serve in the military, including national Guard or Reserve? Yes No
Is the parent or guardian currently serving on active duty or expect to be deployed this year? Yes No
Has a parent or guardian returned from deployment in the last six months? Yes No
Bloomingdale School District 13 164 Euclid Avenue
Bloomingdale, Illinois 60108-2604
John T. Reiniche Director of Finance
630-671-5035
Jan Konchar Administrative Assistant
/Bookkeeper 630-671-5031
Geri Zanoni Payroll
630-671-5032
Fax 630-893-1818
BLOOMINGDALE SCHOOL DISTRICT 13 2018-2019 REGISTRATION FEE WAIVER APPLICATION
The Board of Education of Bloomingdale School District 13 waives school fees for children whose parents are experiencing
economic hardships. If you believe your child(ren) may qualify for a fee waiver due to current financial or emergency
conditions, please complete this form and return it with the registration materials. If you have any questions, please
contact the Administrative Assistant/Bookkeeper, at 630.671.5031. You will be notified of acceptance or denial within 14
days. ----------------------------------------------------------------------------------------------------------------------------------
Name of Student: ______________________________________________ School _________________
Name of parent or guardian: _____________________________________ Grade _________
I hereby request school fees are waived for the above listed student for the following reason:
Household Income Section:____________________________________________________________
[ ] The student’s household gross income meets the Federal income requirement for waiver approval. Documentation must be
attached that supports household size and gross income level. The following documents must be enclosed: Recent W-2
form(s); recent pay stub; Front page of most current Federal 1040 tax form.
Household
Size
Annual Household
Income (Gross)
Monthly Household
Income (Gross)
Weekly Household
Income (Gross)
[ ] I have attached a copy of my most current pay stub
[ ] I have attached a copy of my most current W-2 form (s)
[ ] I have attached a copy of my most current Federal 1040 tax form showing dependents
OR
Public Aid Section: ___________________________________________________________________
[ ] The household is receiving public aid (i.e. Aid to Families with Dependent Children (AFDC), Temporary Assistance for Needy
Families (FANF), or Department of Human Services Food Stamps). Evidence of participation in AFDC, TANF, or Food Stamp
Program must be attached. LINK card and Illinois Department of Public Aid MediPlan cards will not be accepted as
verification of pubic aid.
[ ] I have attached a copy of my card indicating participation in AFDC, TANF or Food Stamp Program.
Case ID Number: ______________________________________________________________
I have reviewed the District’s policy and I am aware supplying false information is a class 4 Felony (720 ILCS S/17-6). I attest
that the statements made here are true and correct.
_________________________________________________________________ _____________________ Parent Signature Date
*********************************************************************************************
Office Use Only:
____ Approved ____ Disapproved
Director of Finance’s Signature: __________________________________________________ Date: _________________
HEALTH SERVICES
February 2018
Dear Parent/Guardian:
In just a short while, we will be registering your son or daughter into Bloomingdale SD 13’s Kindergarten Class! Welcome!
This letter is to inform you about the initial steps you need to take to prepare your student for the start of the 2018-2019 school year with regard to mandated health, medical, and dental forms. All of the mandated forms will be provided to you at Kindergarten Visitation in April. Please be aware that physicians’ and dentists’ offices are very busy during the summer; be certain to book your appointment early!
Illinois state law mandates that all kindergarten students have the following upon entrance to school:
1. A current physical exam recorded on the approved form, completed and signed by your physician aswell as a completed and signed parent section. (The physical exam is due before the first day ofschool and must be dated within one year of the first day of the 2018-2019 school year.)
2. A complete record of mandated immunizations; current vaccination requirements will be shared withyou at the Kindergarten Visitation in April.
3. A current oral health exam recorded on the approved form and signed by your dentist. This exam isnot due to your student’s building Health Office until May of 2019.
4. A current eye exam recorded on the approved form and signed by your eye doctor. (The eye exam isdue before the first day of school and must be dated within one year of the first day of the 2018-2019school year.)
All mandated forms and an update on required immunizations will be given to you at Kindergarten Visitation in April; you may also obtain these forms from your medical and eye physicians and dentist.
If you are unable to provide a physical exam, immunizations, dental or eye exam for your child, please contact the DuPage County Health Department at 630.682.7400 for assistance.
If you have any questions, please call your student’s building’s Health Office.
Sincerely,
Health Services Bloomingdale SD 13 Bloomingdale, IL 60108
Why we're different from other fundraising groups: • All contributions made to the foundation are tax deductible• 100% of the contributions go directly back to the teachers and students of our district• Teachers are able to determine how the donations are utilized
Projects we've funded in the past: • eReaders for 7th grade students • special music and reading programs• a climbing wall with accessories • projectors and speakers• technology and multimedia projects • Nook books
How you can help: • Make a financial donation using the form below and return it in your registration packet• Volunteer your time to help organize fundraisers and solicit donations• Provide services to the foundation, such as printing, signage, etc.
Please make checks payable to the: Bloomingdale SD 13 Education Foundation PO Box 6382 Bloomingdale, IL 60108
Enclosed is my donation of: $30 $50 $75 $100 Other
Please contact me about volunteering or donating services
Name: Email:
Address:
Phone:
THE STUDENTS AND TEACHERS THANK YOU FOR YOUR SUPPORT!
Our Mission Due to budget cuts and economic times, there has been a decrease in the amount of traditional funding for public education. The Bloomingdale School District 13 Education Foundation was founded in 1998 as a non-profit dedicated specifically to supporting the children and staff of our district. Our mission is to raise supplemental funds to support creative and innovative projects that benefit all of the children in District 13.
