NCSD STUDENT REGISTRATION

INSTRUCTIONS: The Registration form is an official record. The questions on the form ask for important information that will help provide services for your child. Some of the questions are explained below. If you need further information, please contact your school. Please print using a ball-point pen, completing both pages.
Please complete the form below. Mandatory fields marked *

STUDENT INFORMATION- If student is living in any of the following circumstances, additional services may be available: sharing housing with friends or family, living in a shelter or motel, or if you are a student who is living away from your parent or legal guardian. Please check the box and notify office staff.

Student Information
  1. Female Male
  2. Yes No
  3. Yes No
  4. American Indian or Alaska Native Asian White Black or African American
    Native Hawaiian or Other Pacific Islander
  5. Yes No
  6. FROM TO
  7. (This information establisheds the District's Eligibility for a federal grant under Title IV-A of the Indian Education Act. Complete information will be sent to students marking "yes" on this item.)
    Yes No
  8. Yes No
    If YES, please complete the following
  9. Yes No
    Yes No
    Yes No
Parent/Guardian Information
  1. Both Parents Mother Father Grandparent Guardian Foster Parent
    Other



  2. Mother Father Guardian Other
  3. Yes No Contact Order #:
  4. Living with Student? Yes No
    Same as student address? Yes No
    If no, please fill in below:
    Check to recieve copy of report card/ correspondence

  5. Yes No
  6. Yes No
  7. (ESTABLISHES DISTRICT ELIGI- BILITY FOR FEDERAL FUNDING)
    Yes No
    (To qualify for migrant education services, a child must have moved within the past three (3) years across the school district, city, county, or state lines wiht their parents or guardians to obtain temporarty or seasonal employnent in agricultural or fishing activity.)
    Yes No



    Mother Father Guardian Other
  8. Yes No Contact Order #:
  9. Living with Student? Yes No
    Same as student address? Yes No
    If no, please fill in below:
    Check to recieve copy of report card/ correspondence

  10. Yes No
  11. Yes No
  12. (ESTABLISHES DISTRICT ELIGI- BILITY FOR FEDERAL FUNDING)
    Yes No
    (To qualify for migrant education services, a child must have moved within the past three (3) years across the school district, city, county, or state lines wiht their parents or guardians to obtain temporarty or seasonal employnent in agricultural or fishing activity.)
    Yes No
Additional Emergency Contacts (In emergency, parent/guardians on page 1 will be called 1st and 2nd unless shown otherwise below)
    CONTACT #1
  1. 1st 2nd 3rd 4th 5th
  2. Yes No
    CONTACT #2
  1. 1st 2nd 3rd 4th 5th
  2. Yes No
Medical Information School staff need to know when your child has a current ongoing health problen for which he or she may require help during the school day. Remember to advise your school of any changes in information.
  1. Asthma Heart Disease Seizure Disorder Diabetes Type I Type II
    Date of Diagnosis Serious Allergies Other
Siblings (Attending same school district.)

Academic Information
Student Essays

This essay needs to be completed for your application to be considered complete. The quality of this essay will not determine your acceptance. However, it will let help us learn more about you. You may have a learning specialist help you. Please answer the following question in essay form. Your essay must have at least 2 paragraphs.

  1. #1 Why do you want to attend Clackamas Middle College? Please be honest.
  2. #2 What are your personal and academic goals while enrolled at CMC?
PERMISSION INFORMATION - A PARENT MAY SUBMIT A CHANGE TO THIS REQUEST, IN WRITING TO THE SCHOOL OFFICE, AT ANY TIME DURING THE SCHOOL YEAR.

    INTERNET ACCESS/DIRECTORY INFORMATION - STUDENTS WILL BE GRANTED INTERNET ACCESS AND EMAIL ACCOUNTS. UNDER FEDERAL LAW AND SCHOOL POLICY, THE SCHOOL DISTRICT MAY RELEASE THE FOLLOWING INFORMATION WITHOUT PRIOR CONSENT: Student name, participation in officially recognized activities and sports, weight and height of members of athletic teams, degrees, honors and awards receieved, major field of study, dates of attendance, and the most recent school attended. If you do not want this information released, please submit a written request to your school. This request must be completed each year.

    Student photos, videos and student work are commonly used in yearbooks, newsletters, websites, and other school related publications. If you do not want your student's photo, video, or work used or released for these purposes or for news media, please contact your school to submit a written request.

MEDICAL EMERGENCY TRANSPORT
    EVERY STUDENT HAS THE RIGHT TO BE TRANSPORTED IN CASE OF A MEDICAL EMERGENCY. EMS (EMERGENCY MEDICAL SYSTEM) MAKES FINAL DECISION FOR SITE OF BEST AVAILABLE CARE WHEN SERIOUS ILLNESS, ACCIDENT, OR OTHER EMERGENCY EVENT DIRECTS NEED FOR TRANSPORTING TO A HOSPITAL. IF POSSIBLE, THE SCHOOL WILL ADVISE EMS OF YOUR HOSPITAL PREFERENCE.
MILITARY/COLLEGE RECRUITMENT - HIGH SCHOOL STUDENTS ONLY

    THE ‘NO CHILD LEFT BEHIND’ ACT OF 2001 REQUIRES SCHOOL DISTRICTS TO PROVIDE, UPON REQUEST, THE NAMES, ADDRESSES AND PHONE NUMBERS OF JUNIORS AND SENIORS TO MILITARY RECRUITERS, COLLEGES AND UNIVERSITIES. IF YOU DO NOT WANT THE SCHOOL DISTRICT TO PROVIDE INFORMATION ABOUT YOUR STUDENT TO EITHER THE MILITARY OR COLLEGES AND UNIVERSITIES, YOU HAVE THE OPPORTUNITY TO ‘OPT OUT’. IN ORDER TO DO SO, YOU MUST CHECK NEXT TO ONE OR BOTH OF THE FOLLOWING CATEGORIES:

    NO MILITARY RECRUITERS NO COLLEGE/UNIVERSITY RECRUITERS
SIGNATURES