WKOJlbHbllil OKPYr A3B~AA AArllACA Y'-1 EH 111'-1 ECKAH PEriACTPAL.J.IAOH HAH AH KET A

en1CTpa4HOHHaR aHKeTa Bawero yl.faw.erocR sa>t<Ha AnR Bac H AnR wKonbHoro oKpyra

Y4eHI14eCKI1e peri1CTP34110HHbJe aHKeTbl O'leHb B3)1(Hbl - AJIR Baweii CeMbl1 11 AJIR WKO/lbHOfO OKpyra. CBeAeHI1R, KOTOpbJe Bbi VK33bJBaeTe, 00380/lRIOT HaM:

* noCbl/laTb BaM Ba>KHYIO HHijlOpMal\HIO- WKO/lbHYJO H WKO/IbHOfO OKpyra, BK/lJO'IaA CBeAeHI1A 06 ycneeaeMOCT11 11 noCell.laeMDCTI1 Bawero CbiHa 11/111 A04epl1.

* Pear11pOB3Tb HaAJ1e>Kali.I11M o6pa30M npH He06XOAHMOCTYI OKa3aHI1R BaweMy pe6eHKY MeA111.\11HCKOH nOMOLI.IH.

* CBA3bJBaTbCA c Ba MH 111111 c APYfHMH yKa3aHHbiMI1 e aHKeTe 11HL\aMI1 np1-1 B03HI1KHDBeHHH e wKo/le 4pe3BbJ4ai1Hoi1 CI1TYal\HH.

COAep>Kall.laACA B aHKeTaX 11HijlOpMal\HR cnoco6CTByeT TaK>Ke aKaAeMH4€CKI1M yen exaM y4all.\11XCR, AaBaA WKO/lbHOMY OKpyry B03MO>KHOCTb:

* 0Ka3bJBaTb y4aW,11MCA TaKyJO nDMep>KKy, KaK nDMOW,b B OB113A€HI111 aHf/1HHCKI1M A3biKOM.

* 0 6pall.\aTbCR 3a cy6CHA11AMH AJIR 6onee pe3yllbTaTHBHOrO o6y4eHI1R WK0/1bHI1KOB.

* 01.\eHI1B3Tb Hawy pa60TY C pa3/1114HbiMH KaTerOpi1AMH y4aW,I1XCR (paCOBbiMI1/3THI14€CKI1MI1/, COL\113/1bHbiMI1/3KOHOMI14eCKI1M11 11 T.A.).

* rapaHTHpOB3Tb C061JJOA€HI1€ 33KOHOAaTe/1bHbiX 00110>K€HHH 0 rpa>KAaHCK11X npaeax Y43W,I1XCR 11 CDTPYAH11KOB WKO/lbHOro nepcOHa/la.

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o6CIJY>KI1B3Tb Bawero pe6eHKa. EC/111 HY>KHa nDMOIJ.\b B 33nOIJH€HI111 aHK€Tbl, C006W,HT€ HaM 06 3TOM. 3anOIIHI1Te1 nO)I(a/lyHCTa, BCe CTpaHI11.\bl 4epHOH wapHKOBH

py4KOH 11 pacni1W11TeCb Ha nOC/IeAHeiii CTpaHI11.\e. np11 YI3MeHeHYI YI B T€4€HYI€ yYe6HOrO rDAa yKa3aHHbiX BaMI1 CB€A€HYIH H€M€A11€HHO YIHcj>OpMY1pyi1Te WKO/Iy.

)J\TfHtHHblt rpa4lbl 13DOnHAIOTCR W KOJtblC h lta1 o cll n coM; ENTRY DATE:--- - --- SCHOOL:----------- STUDENT ID # _ ___ _

STUDENT NAME: ___ ____ _________ _ ___ GRADE: ___ _ _ HOMEROOM: -------------- --- - -

BUS# ____ _ BUSSTOP: _________ _ _______ _ _______ _ PICK UPTIME: - ------- -- FTE: _ _ _ _

PROOF OF AG E: - -------- PROOF OF RESIDENCE: - - ------ --- IMMUNIZATION:-- ---- - - --- -

CBEAEHI-1R 06 Yl.fALUEMCR

1. IIIMH (no AOKyMeHraM) _ _ _______ _____ 2. <t>AMIII!llllfl (no AOKyMeHraM) ___ _________ _ _ _ _ _ ___

3. OTlJECTBO ____ _ _ 4. nPEAnOlli-1TAEMOE I-1Mfl ___ _ ___ _ _ 5. nPEAnOlli-1TAEMAfl <t>AMI-1fll.1fl _ _____ _

6. KflACC _ _ 7. noll D>+<eHCKHH D MV>+<CKO~ D HeonpeAe/leHHbl~ 8 . POAHOC1 fl3biK - - --- - - --- -

9. AATA PO>t<AEHIIIH (MecAL\IAeHb/roA) _ _ _ ___ 10. WTAT PO>t<AEHIIIH _ _ __ 11. CTPAHA PO>t<AEHIIIH _ _ _ ____ _ _ __

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12a. 3THIIIlJECKOE nPOIIICXO>t<AEHIIIE -IIICnAHO/ flATIIIHOAMEPIIIKAHCKOE? Aa D HerD (npi1M.: ClleAver CAellaTb OTMeTKI1 B o6ei1X rpacj>ax)

12b. PACA (He MeHee oaHoi1 omMemKu) DAMepHKaHCKHL:! HHAeel\lypo>+<eHel\ AllRCKH DA3Har D llepHbJL:! DYpo>+<eHel\ r /x ocrpoBOB 06ellbll:1

13. AOM. AAPEC _ _________ _ _____ 14. fOPOA _ _ ___ 15. WTAT ______ 16. n04T. KOA ___ _ _

17. nOlJT. AAPEC (eC/lH He coenaAaer c AOMaWHHM) ___ _________ 18. r oPOA ____ _ 19. WTAT _ _ 20. nOlJT. KOA _ _ __ _

21. OCHOBHOC1 AOMAWHIIIC1 TEll. (Mo6HilbHHK? Aa 0 Her 0) _______ 22. M06111JlbHIIIK Y4AW.Ef 0CH ----- - - -

flpHM.: HoMep ,D,OM. TeJJe<jJOHa 6y.ueT HCOO/lbJOBaTbCJI/liUilh )J.JUI nponep1m noCeJJ:IaeMOCTH H B 4pe3Bbl4. Clly4aRX

CBEAEHI-1R 0 WKOnAX. KOTOPbiE Yl.fALUI-1r:iCR nOCELL!An B IIPOlllJIOM

23. WKona (cHa4ana npeAblAVW,aA) 24. fopOA H WTaT 25. fOAbl y4e6bl (HanpHMep, 2007-09)

1.

2.

3.

Rev 23, March 2018

, )> ;:o m z ~ \1'1

m 3l: m ;:o Cl m z Q

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27. 0 MATb 0 OTEL.I 0 OnEKYH 0 1-1HOE:

28. <I>AMW1V1R 29. V1MR

30. POAHOi'! R3biK 31. 3llEKTPOHHbli'! AAPEC

32. BOEHHAR CllY}I{5A: Cny>KHT? Aa 0 HeT 0 Pe3epBI1CT7 Aa 0 HeT D BeTepaH? Aa 0 HeTO

33. nO'-lTOBbli'! AAPEC 34. rDPOA 3S. WTAT ___ 36. nO'-lT. KOA

37. OCHOBHOIII TEllE<I>OH Mo61-1JlbHI1K? AaD HerD 38. BTOPOIII TEll. Mofii1JlbHI1K7 Aa 0 HerO

39.CllY}I{E5Hbl i'l TEll. 40. PA50TOAATEllb

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44. }l{enaer CTarb BOJlOHrepoM? AaD HeTD 45. Hy>KeH 1111 nepeBOA41-1K Ha 6eceAaX s wKone? Aa 0 HeT 0

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rpa4le 53. ECJIH Bbl XOTHTC IIOJIY'I3Tb KOOHH IIHCCM H HH!POpManHH H3 lllKOJibl H OKpyra, C,l(enai1Te J)lCCb OTMCTKY- 0)

47.0 MATb 0 OTEL4 0 OnEKYH 0 1-1HOE:

48. <I>AMV1lll-1R 49. V1MR

50. POAHOi'! R3b1K 51. 3llEKTPOHHbli'l AAPEC

52. BOEHHAR CllY}I{5A: Cny>KHT7 Aa 0 HeT 0 Pe3eps11cr ? Aa 0 HeTD BerepaH? Aa 0 HerD

53. nOYTOBbllll AAPEC 54. rOPOA 55.WTAT _ __ 56. noYT. KOA

57. OCHOBHOi'l TEll Mo611JlbHI1K7 Aa 0 HeT 0 58. BTOPOi'! TEll. Mo61-'!JlbH11K? Aa 0 Her 0

59. CflY}I{E5Hblll1 TEll. 60. PA50TOAATEJlb -

61. Pa3peweHbl KOHTaKrbl c yYaUJ,I1MCH? Aa 0 HeTD 62. V1MeeT oneKy HaA yYaUJ,11MCH? Aa 0 Her 0 63. npaso 3a61-1p3Tb ero? Aa 0 HeT 0

64. }l{enaer CT3Tb BOJ10HTepoM7 Aa 0 HerD 65. Hy>KeH 1111 nepeBOA411K Ha 6eceAaX B UJKOJ1e7 Aa 0 HeT 0

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1111l.\3M fiyAer pa3peUJeHO B T3K11X CJ1Y431lX 33611p3Tb Bawero pe6eHKa 113 L!JKOJ1bl1 KOrAa Mbl He CMO>KeM CBH3arbCil C BaMI1.

66. KEM nPVIXOAV1TCR YYAll(EMYCR 67. VIMR VI <I>AMVIlliiiR

68. AOM. TEllE<I>OH 69. CflY}I{E5Hblll1 TEll. 70. M06VIllbHV1K

71. KEM nPVIXOAHTCR Y'-lA!.4EMYCR 72. VIMR ill <I>AMI1lliiiR

73. AOM. TEllE<I>OH 74. CllY}I{E6Hblll1 TEll. 75.M05illllbHVIK -..:~-:::-:::::::,..,-::::::::=::-..:;.::.·:~. · :;._ -· ·-- -·. ... - - ·· Mt -~o;4,..._ 0:.'- - r."l'llll>lr.IIOIIi' ' "' . ··-b"--· ... ~- --76. KEM nPVIXOAIIITCR YYAll(EMYCR 77. VIMR 11 <I>AMI1lliiiR

78. AOM. TEllE<I>OH 79. CllY}I{E6Hblll1 TEll. 80. M05VIllbHVIK

6PATb.fl 1-1 CECTPbi-YKa>KI-!Te, no>Kan yi1cra, 6paTbeB 11 cecrep, nocew,atOW,14X cei14ac m Kony HnH WKOJlbl oKpyra A3BI4p,a Aarnaca.

81. <I>AMVIll VIR 82. VIMR

83. 5PAT Hll l-1 CECTPA? 84. WKOllA 85. KllACC ---___ , ___ ' .. ····· - . '.-.. ~·" ,. .- .- .. . -.............. ,_,_ ,,,",· "'' -. ~ · ·· ·:-····::::<1!1::::: " ' - ·:· ·: •: ·.:. =--~ ,-~. : .::·:.: -~

86.<!>AMV1lli1R 87. V1MR -

88. 5PAT 11llill CECTPA? 89. WKOllA 90. KllACC - --: ::~ • .: •• : . ..-·. ::_:,:=::::::::::.: '-:-. ..:- '-'··•· ;·--·:;·:::=....-. ~:·::·c·-,; ;: ; ::;.:-- :.o.: c:.-!0... ~ ·· ,;:···:;;.::: :0.::.; >::; -·-~:.:-:.:.:;:;;· ::·::··: .· :· ;,,;::o!;;. ... ······- ~ ~ ·: · · -:··: .:·

91. <I>AMV1lll-1R 92. VIMR

93. 5PAT Vllll-1 CECTPA? 94. WKOllA 95. KllACC

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96. lt!MH lt1 Cl>AMitlflltiH BPAYA (Heo6R3aTe/1bHO) 97. TEflECl>OH (Heo6R3aTe!1bHo)

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99. OTMETbTE lt1MEIOUJ.It1ECH 3A50flEBAHit1H:

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0 CEPbE3HbiE AflflEPr V1V1: OnACHbl ,ll,flfl >KV13HV1? ,ll,A DHET

100. lt!HbiE OC05biE HY>t<,ll,bl B WKOflE, CBH3AHHbiE CO 3,ll,OPOBbEM:

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TOflbKO ~flR YYAlUJ.1XCR ~ETCAAOBCKOro KflACCA

102. npoBOAIII/1 /1111 Baw pe6eHOK He MeHee 5 4aCOB B HeAe/110 B nOC/leAHIIIe 12 M€CRU,eB B AOWKO/lbHbiX yYpemAeHHRX (TaK!-1X KaK

AOWKO/lbHaR rpynna, "Head Start"~-111111 "Childcare Center") AO nocryn!leHIIIR B AeTcaAOBCKIII~ Knacc? 0Aa OHeT

103. Ha111MeHoBaHI-1e AOWKO/lbHOro yY pe>KAeHIIIR

TOflbKO ~flR YYAW,I'IXCR HE CTAPWE 7 /lET

104. npoXOAIII/1 /1111 Baw pe6eHOK npoaepKy 11111111 OCMOTp 3y60B AaHTIIICTOM nOMIIIMO npoBepKIII B WKO!le? Cl ,ll,a Cl Her

105. Ec11 111 Bbl OTBeTIII/11-1 " Her ", TO no KaKO~ npiii4111H€ He 6bl/10 npoaepKIII? (0TM€TbT€ 4TO-H1116VAb OAHO)

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PA3PEWEHJ.1R I corflACJ.1E- CnpaBOYHble CBeAeHI1A, a raK>Ke 11HQJOpMal..ll110 0 AOKyMeHTai..II1H Ha yYa U-111XCR, 0 aep60BKe yYaU-111XCA B apM1110 11 0

3al!-111Te npae yYaUJ,I1XCA 11MeiOTCA e CnpaBO'IHUKe wKonbHOZO OKpyza iJnR poiJumeneu u y4aU{UXCR (District Parent ond Student Handbook).

• CornacHo <PeAepaJJbHOMY 3aKoHy 11 UJKOilbHbiM npas11naM, UJKOilbHbli1 oKpyr Mo>Ker pacKpbiBaTb 6e3 cornac1-1A POA11renei:l cneAYIOUJ,YIO

11HQJopMal..ll110 o6 y4aUJ,11XCA: 11MA "'cj>aMI1JJHA, y4aCTHe s cnopT11BHbiX 11 APYfHX UJKOilbHbiX Meponp11RTHRX, sec 11 poeT YneHoe cnopr11BHbiX KOMaHA,

nOOU-IpeH11R 11 HarpaAbl, npOcj>l11111pytol!-111e npeAMeTbl, speMA yye6bl B UJKOJJe 11 Hai1MeHOBaHI1A UJKOJJ, B KOYOpbiX YYI1/1CR (yYI-1/laCb) paHbUJe. ECJJI1 Bbl

npontB paCKpbiTHR TaKOH 11Hci>OpMa4HH 0 BaweM pe6eHKe, CBR>IUUecb, no>KaJJyHCTa, C ero/ee WKOJIOH 11 nepeAaHTe COOTBeTCTBYIOUJ,YIO

nHCbMeHHYIO npocb6y. TaKytO npocb6y HY>KHO 6yAeT noAaBaTb emerOAHO.

* <!>or orpacj>1111 yYaU-111XCR UJ11pOKO 11CnOJJb3VIOTCA B UJKO/lbHbiX e>Ke fOAHI-1KaX, 610!1/leTeHRX HOBOCTeH, Ha UJKO/lbHbiX CTpaHHU,aX 11HTepHeTa 11 B APYfi1X

CBA3aHHbiX CO UJKO/lOH ny6!111KaU,11RX. ECJJH Bbl He XOTI1Te, YT06bl ci>OTO Bawero WKO/lbHI1Ka nepeAaBa/111Cb 11/111 HCOO/Tb30BallHCb B 3THX 4eJJAX JJH60

ny611HKOBa/THCb cpeACTBaMH MaCCOBOH 11Hci>OpMa41111, CBR)f(HTeCb, no>Kanyi1cra, C ero/ee WKOilOH H nepeAaHTe OHCbMeHHYIO npOCb6y.

* BpeMA or speMeHI1 y4a UJ,I1MCA npeAoCTaBJJRercR B03MO>KHOCTb yyacrsoeaTb a UJKOilbHbiX 3KCKypc11Rx 1-1 npoeepKax 3AOPOBbA. Mbl 6yAeM coo6UJ,aTb

nOAp06HyiO 1-lHQJOpMal..ll-110 06 3TI-1X Meponpi-1ATI1RX. ECJJH Bbl He XOTHTe 3apaHee cornaCHTbCR Ha TO, 4T06bl Baw WKO/lbHHK y'faCTBOBa/1 B HHX,

CBR)f(HTeCb, no>KaJJyHCTa, C ero/ee WKOJIOH H nepeAaHTe OHCbMeHHYIO np0Cb6y.

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AOCyYn K 3JleKTpOHHOH nO'fTe WKOilbHOrO OKpyra, CBR)f(HTeCb, nomaJJyHCTa, C ero/ee WKOilOH H nepeAaHTe nHCbMeHHbiH OTKa3 OT 3TOH ycnyrH •

.R npO'fHTa/l H OOHHMaiO H3/10}f(eHHYIO BbiWe 11Hci>OpMa4HIO 0 pa3peweHHRX/COr/laCHH ----- (ii1HHL\Hanbl POA11Te/1A /oreeTCTBeHHOfO B3pOC110fO)

TOJlbKO A/lR YYAll.li'IXCR WKO/lbl CTAPWI'IX KflACCOB (HIGH SCHOOL)

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JanoniUICTCJI ron••o w•o•"""'" ocj>11coM: STU DENT I D # ______ _ SCHOO~-------- STUDENT NAME: _ __________ _ _

~Hc!>OPMAY~R 0 nPOrPAMMAX

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109.BK11104eH 1111 cei-14aC Baw pe6eHOK B nporpaMMY AJlR Ta11aHT1111BbiX 11 Op,apeHHbiX WK011bHI1 KOB (TAG)? AaD HerO

~H4>0PMAY~R 0 R3biKE

110. KaKo~ 11eKC11KOH CllbiWIIIT 11111111 YacTo IIICnOI1b3VeT Baw pe6eHOK p,oMa (pa3rosopHbiH, ra3eTHbiH, MY3btKa11bHbl~, 111itTeparypHb1~)?

C11yx: V1 cn011b3yer : (Hanp. AMep11KaHCK11~ R3biK >Kecros) _ ___ _ _ _ _

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n11eMeHHOH/ry3eMHbiH R3biK ( R3biKI1 aMepi1KaHCKiitX 11HP,eHL\eB, ypo>KeHL\eB, AJ1RCKI1, rasai-1CKI1X OCTpOBOB lit1111 Teppi1TOplitH CWA)

112. Ha KaKoM R3btKe/R3btKax Yaw,e scero rosopRT p,oMa c Baw11M pe6eHKOM B3poCI1bte? --------- - --------

113. Ha KaKoM RbtKe/R3btKax rosop11T/Bbtpa>Kaer cR CEH'-IAC Baw pe6eHOK yaw,e scero, Korp,a OH He s wKo/le? ______ _ _ _

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115. XoTiitTe 1111 Bbt coo6W,IitTb HaM ew,e 4TO-Hiit6yp,b o R3biKOBOM pa3BiitTiitl1 pe6eHKa? (Hanp., Ha KaKoM R3btKe oH rosoplit11 p,o 4-x 11er,

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