Thank you for choosing St. Francis Xavier Catholic School System! We are honored to be your family’s choice for quality education and faith formation. We look forward to partnering with you in the education and faith formation of your child. To register for the upcoming 2021-2022 school year please complete and submit the following:

One per child of the Student and Permission/Medical Forms (Sheets A, C, D & E)

One per family of the Family Information and the Financial Responsibility Form (Sheets B & F)

The additional campus forms in your registration packet

A $75 per child, non-refundable, registration fee

Completed registrations may be dropped off or mailed to Xavier Catholic Schools, Attn: Admissions, 1600 W. Prospect Ave., Appleton, WI 54914. If you would like your child to experience a St. Francis Xavier Catholic School System education and finances will play a part in that decision, please know that we are committed to making Catholic education available and affordable to all. Information on all of the financial options we offer is available on our website, www.XavierCatholicSchools.org, under the Enrollment tab. Please review both the Tuition Assistance & Scholarship and the Wisconsin Parental Choice Program pages. Please note the following important dates:

Applications for tuition assistance through FACTS Management for the 2021-2022 school year will be accepted beginning Jan. 18, 2021. Current Xavier families, March 12, 2021 is the priority deadline for you to apply for need-based assistance through FACTS. New families may apply at any time until funds are dispersed. Tuition assistance is not automatically renewed; applications must be completed for each school year. If you need assistance after the deadline please contact Admissions (see below).

Applications for merit and need-based scholarships will be accepted through March 2, 2021.

The application window for the Wisconsin Parental Choice Program (WPCP) through the Dept. of Public Instruction is Feb. 1 - April 15, 2021.

We at St. Francis Xavier Catholic School System are dedicated to fulfilling our mission “to provide opportunities for all students to develop a lifelong love and commitment to academics, faith, arts, fitness, and service”. If you have any questions about registration, please feel free to reach out to Admissions at (920) 735-9380 or Admissions@XavierCatholicSchools.org. Many blessings,

Tara Pearce, Vice President of Admissions St. Francis Xavier Catholic School System

Registration/Re-enrollment Fee

The registration fee for new students is $75 per student. The re-enrollment fee for returning students is $75 per student and will be applied to your Smart Tuition account in February 2022. The registration fee is non-refundable.

Tuition Payment Information

There are two payment options for the school year.

1. Pay tuition in full by June 30, 2021.

2. Pay tuition in 10 equal monthly installments from August-May.

Other Fee Payment Information

Other student fees, including but not limited to those listed on the fees sheet, are due when billed.

Tuition Credit Available for Early Payment

If tuition for the 2021-2022 school year is paid in full by June 30, 2021, the family is eligible to receive the Early Payment Credit. This credit is applied August 31, 2021. The Early Payment Credit Form is required and can be found on our website on the Enrollment page and the Enrollment & Tuition tab.

International Student Hosting Credit

Any Xavier School family with children currently enrolled may receive up to a $2,000 tuition discount for hosting an international student for one school year. To find out more, please contact Matthew Parish at (920)733-6632 or mparish@xaviercatholicschools.org.

Partner Parishes

High school students at Partner Parishes are eligible for the parish member annual tuition. Please refer to the “Summary of Billing Policies” on our website for complete information.

Non-Appleton/Partner Catholic Parish Members Are Eligible For a Catholic Discount

Elementary and middle school students with families that are parishioners of non-Appleton Catholic parishes are eligible for a 20% Catholic discount on tuition. Tuition can be calculated as the non-member annual tuition rate minus twenty percent. It will be applied after the start of school upon confirmation of parish membership. High school students that are members of a supporting Neenah/Menasha parish currently receive the member tuition rate.

St. Francis Xavier Grade Level

Parish Member Annual Tuition

Non-Member Annual Tuition

Early Payment

Credit

Pre-K 3 MWF a.m.

$1,790

$1,790

$36

4K M-F half day

$2,380

$2,380

$48

Kindergarten

$3,090

$5,280

$62

Elementary** 1st—4th

$3,800

$5,990

$76

Middle School** Grade 5

$4,300

$6,575

$86

Middle School** Grades 6-8

$4,870

$7,270

$97

High School** Grades 9-12

$7,500*

$10,230*

$150

* The Xavier tuition listed above covers up to 8.5 credits. Summer School classes will have a separate fee and would be payable at the time of registration. There are additional charges for dual credit college courses.

** Please note that additional fees may be charged throughout the year for participation in specific classes or school-sponsored activities. Please see the Student Participation Fee Schedule for specific fee information.

Financial Responsibility

St. Francis Xavier Catholic School System recognizes the individual who registered the student and signed the Financial Responsibility Form as the financially responsible party unless another individual assumes financial responsibility for the student via written notice. One individual or one married couple must be identified as the responsible party for each student regardless of other legal arrangements.

Please refer to the “Summary of Billing Policies” available on our website, www.xaviercatholicschools.org, on the Enrollment page and the Enrollment & Tuition tab.

2021-2022 Tuition Information

2021-2022 Student Participation Fees

Fine Arts Grades 4-8 Grades 9-12

Band $125 $125

Chorus NA $75

Orchestra $125 $125

Athletics (Per Sport) Grades 5-8 Grades 9-12

Baseball NA $180

Basketball XYBA Fees $180

Cross Country $65 $180

Dance Team/Cheer $65 $180

Football Fox Valley Saints

Fees $180

Golf NA $180

Hockey – See Fox Cities Stars

NA FCS Fees

Soccer NA $180

Softball $65 $180

Tennis $65 $180

Track $65 $180

Volleyball $65 $180

Wrestling $65 $180

Other Grade 5-8 Grades 9-12

Robotics * $150 $180

FBLA * NA $180

Mock Trial * NA $180

Forensics * NA $180

** This is not meant to be an exhaustive list of student participation programs. Other fees may apply.

* Fee covers costs through state activities only. If the club advances to Nationals and/or Worlds, students will be responsible for travel and related expenses. Scholarships may be available. Consult with the building principal. ** Fee covers membership general costs. Costs associated with certain club’s travel is the responsibility of the student. Costs will be determined at a later date. Scholarships may be available. Consult with the building principal.

Participation fees are applied to your family’s Smart Tuition account and are due when billed. For example, a fall athletic program would be billed in fall and a spring athletic program would be billed in spring.

Admissions is available to confidentially answer your questions at

(920)735-9380 or by email to Admissions@XavierCatholicSchools.org

If you would like your child to experience a St. Francis Xavier Catholic

School System education and finances will play a part in determining if you

can join us, please know that we will do everything possible to assist you.

We are committed to making Catholic education available and affordable to all. Below you will find some options you might consider.

Catholic Education Within Reach

More information is available on our website.

www.XavierCatholicSchools.org

Click on Enrollment, then Tuition Assistance and Scholarships

All families are able to save on tuition and school fees with the purchase of gift cards through our

Scrip program. Families can begin purchasing Scrip for their child at any time. On April 1st, current

Xavier families begin earning Scrip credit for the next school year. More information can be found

on our website by clicking on the QUICKLINKS tab in the upper right.

Confidential, needs-based financial assistance is available through our school system.

Approximately $380,000 is available for tuition assistance each year. Families can apply online

through FACTS Management via the link on the Tuition Assistance and Scholarships page of our

website. This process includes an online application and the submission of supporting paperwork.

Early application is to your advantage. Families can begin applying for financial assistance with the

start of registration in February.

Scholarships are offered through the St. Francis Xavier Catholic School System Foundation. We are

blessed to have a strong Foundation supported by alumni, current and past system families, staff

and the community at large. There are multiple scholarship opportunities for students. Details on

scholarships can be found on our website. Applications for the 2021-2022 scholarships will be

accepted from November 1, 2020 through March 1, 2021.

Families that qualify by income and residency may consider applying for a voucher through the

Wisconsin Parental Choice Program (WPCP) via the Department of Public Instruction (DPI).

Vouchers are awarded on a lottery basis and cover the cost of the base tuition and registration fee.

If selected, vouchers can be renewed to follow your child through 12th Grade. Information on

income eligibility, open application dates and program details can found on the Xavier Catholic

School website Enrollment page under Wisconsin Parental Choice Program. Qualifying families

may complete the application from home or can request confidential assistance with this process

by reaching out to Tara Pearce, Vice President of Admissions, at (920)735-9380. All applicants and

participants must provide proof of residency annually.

Wisconsin allows a state income tax deduction for elementary and secondary school tuition

expenses. Consult your tax advisor for more information.

Parishioners of Catholic parishes should consult their pastors to determine if additional scholarship

opportunities are available.

Consider hosting an International student attending Xavier High School. Any Xavier Catholic School

family with children currently enrolled may receive up to a $2,000 tuition discount for hosting a

student for one school year, a stipend of $500-$600 per month, and the opportunity for an incredible

intercultural experience. Contact Matthew Parish, mparish@xaviercatholicschools.org or

(920)733-6632, ext. 6253 for more information.

Scrip

School System Tuition Assistance

Foundation Scholarships

Wisconsin Parental Choice Program (WPCP)

Tax Deduction

Parish

International Student

A St. Francis Xavier Catholic School System

New Student Registration

STUDENT INFORMATION

Family: ____ New to Xavier ____ Current Xavier Family

Student: ____ New to Xavier ____ Re-Enrolling with Xavier

School Year Applying For: ______________

Grade Level (circle choice) Elementary* Middle School High School

PK3 4K K 1 2 3 4 5 6 7 8 9 10 11 12

* If Elementary, please indicate preferred campus. If no choice is selected, one will be assigned. ____ Xavier Elementary Marquette Street ____ Xavier Elementary McDonald Street

Student Name _____________________________________________ Home Phone ___________________ Last First Middle Initial

Address ____________________________________ City ___________________ State & Zip _____________

Date of Birth _________/___________/_________ Gender (Circle) Male Female

School District _____________________________ School Last Attended ________________________

Religion ___________________________________ Parish ____________________________________

Ethnicity (For statistical purposes only): Is this student of Latino/Hispanic ethnicity? ____ Yes ____No

Race (circle all that apply) (W) White (B) Black or African-American (A) Asian (I) American Indian or Alaska Native (P) Native Hawaiian/Other Pacific Islander

Primary Language Spoken _____________________

I am interested in: _____ Before Care (PK – 4th) _____ Extended Care (PK3 & 4K) _____ After Care XE (PK3 – 4th) _____ After Care XMS (5th – 8th) _____ Summer (PK3- 6th) Must be registered for upcoming school year.

If your family will be new to XE and/or XMS, are you interested in a parent mentor? (circle one): yes no

As parent/guardian, I understand that the acceptance of this student is contingent upon receipt of: (1) The complete registration packet with signatures where noted. We accept one per family of the

Family Information and the Financial Responsibility forms (FORMS B & F) when multiple students are registered at the same time.

(2) Payment of $75 per child, non-refundable, registration fee (3) Review and approval of learning needs (4) Approval of registration by Administration

I believe, to the best of my knowledge, that all data and information submitted in this registration is truthful and accurate and that no material fact has been omitted.

Signature _______________________________________________ Date _________________________

REGISTRATION FEE: $75.00 per child (non-refundable). Check to be payable to Xavier Catholic Schools. Mail to: Xavier Catholic Schools, Admissions, 1600 W Prospect Ave., Appleton, WI 54914.

OFFICE USE ONLY: Registration date/time: __________________________ By _________________At ____________ Amount Paid $ ________________________ Cash or Check # ____________ Late Start Date _________________ Smart Tuition_____ Family # ______________________ Student # _____________________

B

St. Francis Xavier Catholic School System New Student Registration

FAMILY INFORMATION

(Complete one per household)

Student Name(s) ____________________________________________________________________________

Mother Father

Name ___________________________________ ____________________________________ Address* ___________________________________ ____________________________________

*Complete ONLY if different from student’s *Complete ONLY if different from student’s

Home Phone* ___________________________________ ____________________________________ *Complete ONLY if different from student’s *Complete ONLY if different from student’s

Religion ___________________________________ ____________________________________ Parish ___________________________________ ____________________________________ Employer ___________________________________ ____________________________________ Position ___________________________________ ____________________________________ Work Phone ___________________________________ ____________________________________ Cell Phone ___________________________________ ____________________________________ Primary E-Mail ___________________________________ ____________________________________ Parents Martial Status (circle) Married Single* Divorced* Separated* Widowed Student lives with (circle) Both Parents (Together) Both Parents (Separately) Mother (Only) Father (Only) Mother & Step-Father Father & Step-Mother Legal Guardian Parent Deceased Father ____ Mother _____ Stepmother Name _________________________ Stepfather Name ___________________________ All reports and non-financial communications will be sent to both parents unless court ordered exception. *Please list any court ordered guardian alerts. Documentation is needed for student file. Please attach. __________________________________________________________________________________________

__________________________________________________________________________________________

C St. Francis Xavier Catholic School System

MEDICAL INFORMATION AND PERMISSION

(Complete one per student)

Student Name: _____________________________________

Learning Alerts Please list any conditions that impact your student’s educational experience during the school day (i.e. ADD/ADHD, Asperger’s, migraines, dyslexia, etc.)

__________________________________________________________________________________________ __________________________________________________________________________________________ Medical Alerts/Allergies Please help the faculty and staff at Xavier Catholic Schools be proactive by listing any medical alerts that pertain to your student. A medical alert is a diagnosed medical condition to which teachers and staff members should be made aware in PowerSchool. These alerts may include allergies (note EpiPen if applicable), asthma (note inhaler if applicable), diabetes, seizures, epilepsy, migraines, etc.

__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ I give my permission to Xavier Catholic Schools to publish the above-noted Medical Alerts in PowerSchool. I understand that access to this portion of the student records is granted to employees of Xavier Catholic Schools who have been determined by administration to have job functions which may require or benefit from knowledge of this information. ___________________________________________ _________________________________________ Parent Name (please print) Parent Name (please print) ___________________________________________ _________________________________________ Signature Date Signature Date In case of emergency, the person to contact if parents are unable to be reached:

Name ______________________________________ Phone _________________________

Relationship to Student ___________________________

D St. Francis Xavier Catholic School System

OTHER INFORMATION FORM

(Complete one per student)

Student Name _____________________________________

Grandparent Information

Name _____________________________________ Name ____________________________________ Street _____________________________________ Street ____________________________________ City _____________________________________ City ____________________________________ State __________________ Zip __________ State __________________ Zip _________ E-Mail _____________________________________ E-Mail ____________________________________

If your family will be new to Xavier Catholic Schools, how did you hear about us? (please circle one )

Advertising Alumni Online Search Parish Referral (Friend/Family) _________ Realtor/Relocation Other (list) ___________

Appleton Catholic School Alumni: Please complete below if you attended an Appleton Catholic school.

High School (Grad year) Middle School (Grad year) Elementary School (Grad year)

Mother______ Mother ______ Mother ______ Campus _________ Father ______ Father ______ Father ______ Campus _________

Mother’s Maiden Name _________________________________

Parent/Guardian Agreements for All Students By enrolling my son/daughter at a St. Francis Xavier Catholic School System, I agree to the following: Please initial each box granting permission and/or agreement to each statement.

I/We give my/our consent for St. Francis Xavier Catholic School System to use my son/daughter’s name, image and/or voice recording in school advertising campaigns, publications and/or productions (e.g. newsletters, annual report, brochures, student directory, web pages, play bills, student newspapers.) I/We agree to read and sign the Acceptable Use Policy regarding the proper use of school technology. I/We understand that unless this agreement changes significantly, it is in effect for the time my son/daughter is a student at St. Francis Xavier Catholic School System. I/We agree that I/we will read the campus Parent Handbook, the Student Handbook (where applicable) and the Athletic Code of Conduct (where applicable). I/We and my/our child/children will abide by the expectations (and consequences) set forth in these handbooks. Acceptance in the current year does not guarantee a student’s admission in any subsequent year. Among the factors to be evaluated in deciding whether or not a student will be accepted for continued enrollment at a system campus will be the student’s academic standing as well as the student’s and family’s overall conduct as aligned with the mission and values of the System.

Signatures Parent/Guardian ______________________________________ Date ___________________ Parent/Guardian ______________________________________ Date ___________________

E

Form Date: January 7, 2013

F Financial Responsibility Form

This form MUST be completed and returned to St. Francis Xavier Catholic School System or your student’s registration process will be considered incomplete. Please call the Finance and Administration Department at (920) 735-9380 if you have any questions. Xavier partners with Smart Tuition for tuition management. We encourage all families to sign up for ACH payments through Smart Tuition. The information is/or will be available on your account through Smart Tuition.

Student Name(s):

Please list students in order of oldest to youngest and include last names if different from that of the responsible party listed in Section A below.

Section A – Identification of Financially Responsible Party

St. Francis Xavier Catholic School System recognizes the individual who registered the student and signed the Financial Responsibility Form as the financially responsible party unless another individual assumes financial responsibility for the student via written notice. One individual or one married couple living at the same address must be identified as the responsible party for each student regardless of divorce arrangements. (Please provide any documentation on a divorce that will assist us.)

After reviewing the “Summary of Tuition Billing Policies & Practices” available on our website, www.xaviercatholicschools.org, on the Enrollment page and the Enrollment & Tuition tab, please complete the following:

Financially Responsible Party:

Statement Street Address: Statement City, State, Zip:

Billing Email: Billing Phone Number:

Section B – Eligibility for Employee Discount

Please complete if a parent of this student is or will be employed at Xavier Catholic Schools, an Appleton Parish or a regional parish school. Regional students qualify if their parish doesn’t have school for their grade level. Employment will be verified before the discount is applied.

Name of Parent Name of Employer

Section C – Acceptance of Financial Responsibility

I have reviewed the “Summary of Tuition Billing Policies and Practices” and the “Tuition Information” sheet and understand my full financial responsibility for the tuition and fees associated with the student(s) named on this form.

_____________________________________________ ___________________ Signature of Financially Responsible Party Date

This document is void if the signature here does not match the name printed in Section A above. If the responsible party is a married couple only one signature is required.

____________________________________________ Social Security Number of Financially Responsible Party

Opportunity for Tax-Deductible Donation to the St. Francis Xavier Fund

A donation to the St. Francis Xavier Fund is the best way to support the academic and spiritual development of our students. Tuition only covers approximately 60% of the average total cost of educating each student at Xavier Catholic Schools. Please consider donating to help make up the remaining gap which averages $2,500 per student. Enclosed is my donation to the St. Francis Xavier Fund. Please make check payable to Xavier Catholic Schools.

___ $100 ___ $500 ___ $1,000 ___ $1,500 ___ $2,500 ___ Other $________ Please designate my gift in the following manner:

___ Greatest Need ___ Tuition Assistance ___ Academics and Technology ___ Fine Arts

**Original to student´s cumulative file, copy to ELL file as applicable.

English Learner (EL) Program

Madeline Brege, EL Teacher (Maestra EL) St. Francis Xavier Catholic School System mbrege@xaviercatholicschools.org

Home Language Survey

Student: _______________________ Grade starting at Xavier: ______ Campus: _________ Date of birth: ___________

This information determines whether your child will be considered for extra English language support. Answers will not be used

for purposes related to legal status or immigration. Based on your answers, if your child is tested & identified for English language

services, you may still decline services offered to your child.

1. Was English the first language used by this student? □ yes □ no 2. Does he / she hear or use a language other than English more than half of the time…

At home? □ yes □ no With parents / guardians? □ yes □ no With other caregivers? □ yes □ no With brothers / sisters? □ yes □ no With other children in their home? □ yes □ no

3. If the student hears or uses any language(s) other than English, please list: _______________________ 4. What language(s) do you prefer for school communications?

Written: □ English □ Spanish □ Other: _______________ Spoken: □ English □ Spanish □ Other: _______________ Parent/Guardian Signature_____________________________ Date____________________ Thank you!

Encuesta de Idioma(s) del Hogar

Alumno: _______________________ Grado empezando en Xavier: _____ Escuela: _________ Fecha de nac.: __________

Esta información determina si su hijo será considerado para apoyo adicional en el idioma inglés. Las respuestas no se utilizarán para fines relacionados ni con el estatus legal ni la inmigración. Según sus respuestas, si su hijo es evaluado e identificado para recibir servicios de inglés, aún pueden negar los servicios que se le ofrecen.

1. ¿Era el inglés el primer idioma usado por el estudiante? □ sí □ no 2. ¿Escucha o usa el estudiante un idioma que no sea inglés más que la mitad del tiempo…

en la casa? □ sí □ no con padres o tutores legales? □ sí □ no con otros cuidadores? □ sí □ no con hermanos? □ sí □ no con otros niños en la casa? □ sí □ no

3. Si el estudiante escucha o usa un idioma que no sea inglés, favor de decir cuál(es): ___________________ 4. ¿Qué idioma(s) prefiere usted para comunicaciones con la escuela?

Escrito: □ inglés □ español □ otro: _______________ Oral: □ inglés □ español □ otro: _______________

Firma de un padre o tutor legal________________________________ Fecha______________ ¡Gracias!

Xavier Catholic Schools Pre-Enrollment QuestionnaireEspañol en el reverso

Dear Parents & Guardians:In order to better serve your child and to help make plans for his/her education within the St. Francis Xavier Catholic SchoolSystem, we are requesting that you complete the questions below. Your child will not be scheduled for any class or assigned ateacher until the return of this information. If you have any questions feel free to call the principal.

Directions: Please check “yes” or “no” for each statement as it pertains to your child. Please explain all YES answers on aseparate sheet of paper and provide documentation.Student Name:__________________________________________ Current grade:___________Current School:__________________________________________ City:__________________________

Please check…. YES NO

Has your child been offered ELL (English Language Learner) testing (i.e. ACCESS testing) todetermine their level of English language proficiency?

Is your child receiving pull-out or classroom assistance for ELL (i.e. an IndividualizedLanguage Plan, ILP) or have they received these services in the past?

Past

Current

Has your child been evaluated for learning concerns (i.e. area public school districtevaluation, outside evaluation from a doctor/psychologist/neuropsychologist)?

Public School District

Outside Evaluation

Is your child receiving services from an IEP (Individual Education Plan), ISP (IndividualizedService Plan), Section 504 plan, or building plan?

IEP ISP

504 Building Plan

Is your child receiving literacy, math, and/or social skills intervention(s)/support (i.e.Response to Intervention services/plan)?

Literacy

Math

Social Skills

Have you refused or not accepted services from an IEP or ISP?

Is your child receiving speech or language services or have they received these services inthe past?

Past

Current

Would you like your child to meet with a school counselor to discuss your child’ssocial-emotional needs (i.e. anxiety, social concerns, etc.)?

Has your child been part of a TAG (Talented and Gifted) program?

Is your student currently enrolled in accelerated classes or above grade level courses?

Has your child been suspended or expelled from school?

Has your child been involved with school administration and/or law enforcement regardingbehavior?

Has your child had extended absences in the past or attendance issues?

Please contact Natalie Fuller, Learning Services Coordinator, if you have any questions regarding Learning Services supports,interventions, and/or plans @ nfuller@xaviercatholicschools.org.

I grant permission for the staff of St. Francis Xavier Catholic School System to communicate with the personnel of the school listedabove concerning my child (named above) for the purpose of educational planning. This agreement will expire 8 months from thedate of the signature. I further acknowledge that to the best of my knowledge the information I have provided is accurate. Iunderstand that intentionally providing false information could result in denial of enrollment of my child.Parent/Guardian Signature: _________________________________________ Date:__________________Parent/Guardian Name (printed):__________________________ Telephone Number:_______________

Cuestionario de preinscripción de las Escuelas Católicas XavierEnglish on reverse

Estimados padres y tutores legales:

Para servir mejor a su hijo y ayudarles a hacer planes para su educación dentro del Sistema Escolar Católico de St. FrancisXavier, pedimos que usted contesta las preguntas debajo. No se programará para su hijo ninguna clase ni se le asignará unmaestro hasta que se entregue esta información. Si usted tiene alguna pregunta, no dude en llamar al director.

Instrucciones: Marque ‘sí’ o ‘no’ para cada pregunta. Explique todas las respuestas ‘sí’ en otra hoja de papel con documentación.

Nombre del estudiante:___________________________________ Grado actual:___________Escuela actual:__________________________________________ Ciudad:_________________________

Favor de indicar…. SÍ NO

¿Le han ofrecido para su hijo pruebas de ELL (estudiante del inglés) para determinar su nivelde dominio del idioma Inglés? (por ejemplo, con el examen ACCESS)

¿Ha recibido su hijo apoyo de ELL en clase o fuera de clase (por ejemplo, con un PlanIndividualizado de Lenguaje, o ILP) ahora o en el pasado?

en el pasado

actualmente

¿Le han evaluado a su hijo para preocupaciones de aprendizaje (por ejemplo, unaevaluación de un distrito público, evaluación de un doctor/psicólogo/neuropsicólogo)?

de distrito público

evaluación por otros

¿Está recibiendo su hijo servicios de un IEP (Plan Individual de Educación), ISP (Plan deServicio Individualizado), 504 plan o plan de nivel del edificio?

IEP ISP

504 Building Plan

¿Está recibiendo su hijo servicios u intervención de alfabetización, matemáticas, y/o dedestrezas sociales (por ej., servicios o un plan de RTI / ‘Response to Intervention’)?

alfabetización

matemáticas

destrezas sociales

¿Ha usted rechazado o no aceptado servicios de un IEP o ISP?

¿Está recibiendo su hijo servicios de habla o lenguaje, o alguna vez ha tenido tales serviciosen el pasado?

en el pasado

actualmente

¿Le gustaría que su hijo tenga tiempo con un consejero escolar para discutirnecesidades sociales/emocionales? (por ej., ansiedad, preocupaciones sociales, etc.)

¿Ha participado su hijo en un programa TAG (Talented and Gifted)?

¿Está tomando clases accelerados o de nivel más alto que su grado?

¿Alguna vez ha estado suspendido o expulsado de la escuela?

¿Ha estado su hijo involucrado con la administración escolar o con la policia por causa decomportamiento?

¿Ha tenido su hijo ausencias largas o dificultades con la asistencia escolar?

Favor de ponerse en contacto con Natalie Fuller, Coordinadora de Servicios de Aprendizaje, si tenga alguna pregunta sobre apoyos, intervenciones,y/o planes al nfuller@xaviercatholicschools.org.

Doy permiso para que el personal del Sistema Escolar Católico St. Francis Xavier se comunique con el personal de la escuelamencionada anteriormente en relación con mi hijo (nombre arriba) con el propósito de planificar la educación. Este acuerdovencerá 8 meses después de la fecha de la firma. Además, reconozco que, a mi leal saber y entender, la información que heproporcionado es correcta. Entiendo que proveer información falsa intencionalmente podría resultar en la negación de lainscripción de mi hijo.

Firma de un padre/tutor legal: _________________________________________ Fecha:__________________Nombre y apellido del padre/tutor en manuscrito:__________________________ Número de tel.:_______________