Pioneer Valley Regional School District by alicejenny

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									               PIONEER VALLEY REGIONAL SCHOOL DISTRICT
                       SCHOOL CHOICE OPENINGS
                         2012/2013 SCHOOL YEAR

The Pioneer Valley Regional School District is anticipating School Choice openings at
the following grade levels for the 2012/2013 school year.


                              Bernardston Elementary School
                                           K, 6

                               Northfield Elementary School
                                         1, 3, 4, 6

                             Pearl Rhodes Elementary School
                                     K, 1, 2, 3, 4, 5, 6

                               Warwick Community School
                                        2, 3, 6

                             Pioneer Valley Regional School
                                            9

      For applications and information please contact Office of the Superintendent
                    97 F. Sumner Turner Rd., Northfield, MA 01360
                           (413) 498-2911 Fax (413) 498-0045
                      email: LawrenceP@pioneervalley.k12.ma.us
                    or go to: www.pioneervalley.k12.ma.us/PVRSD/
                              for School Choice Application


The Pioneer Valley Regional School District is committed to ensuring that no student is
denied access to any educational program or activity of the Pioneer Valley Regional
School District for reason of race, color, national origin, religion, creed, age, handicap,
gender, or sexual orientation.
  Pioneer Valley Regional School District
        Bernardston – Leyden – Northfield - Warwick           Please return form to:
                                                              PVRSD
                                                              Office of the Superintendent
             SCHOOL CHOICE                                    97 F. Sumner Turner Rd.
            APPLICATION FORM                                  Northfield, MA 01360
                                                              Ph.: 413-498-2911 Fax: 413-498-0045
                2012/2013

Student Name                                                            Date of Birth

_________________________________________________                   __________________
Last              First             Full Middle                     Month/Day/Year

Please check the school you would like your child to attend:
B.E.S. ___ P.R.E.S. ___ N.E.S. ___ W.C.S. ___ P.V.R.S. ___

_______________________________________          ____________________________________
Name of Current School (If applicable)                       City/Town

Grade Student Will Be Entering: ______________

Why do you wish to enroll your child in the Pioneer Valley Regional School
District?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Kindly note that the Pioneer Valley Regional School District is not responsible
for providing transportation to and from school.
Please check if you would like your name given to other residents of your town
for carpooling. Yes_____ No_____


_______________________________________
Parent/Guardian Name (Please Print)
                                                       ______________________________
_______________________________________                            Address
Parent/Guardian Signature                              ______________________________

Email ____________________________________             ______________________________

Phone ______________________________________            Date_______________________
      Day                 Evening

THE PIONEER VALLEY REGIONAL SCHOOL DISTRICT IS COMMITTED TO INSURING THAT NO
STUDENT IS DENIED ACCESS TO ANY EDUCATIONAL PROGRAM OR OTHER ACTIVITY OF THE
PIONEER VALLEY REGIONAL SCHOOL DISTRICT FOR REASON OF RACE, COLOR, NATIONAL
ORIGIN, CREED, AGE, DISABILITY, GENDER OR SEXUAL ORIENTATION.
**Grade 7-12 applicants please include PVRS forms below**
                                  PIONEER VALLEY REGIONAL SCHOOL
                                   Student’s Permanent Record Information


Print Last Name                                          First Name                              Full Middle Name

Student’s Birth date: Month __________________ Day ___________________ Year ___________________

Birthplace: Town ____________________________________________________ State ________________

Father’s First Name                             Middle Name                              Last Name

Mother’s First Name                             Maiden Name                              Last Name

Step-parent’s Name & Address (if applicable)___________________________________________________
                                           ____________________________________________________
Guardian’s Name & Address (if applicable) _____________________________________________________
                                           ____________________________________________________
Joint Physical Custody Name & Address (if applicable) ___________________________________________
Joint Physical Custody Name & Address (if applicable) ___________________________________________

Student lives with: ________________________________________________________________________

Residential Address: _______________________________________________________________________
                     Street Address                      Town              State    Zip Code

Mailing Address (if different): _______________________________________________________________

Telephone Number: __________________________                 *Student’s Social Security # ____________________

*Father’s Place of Employment: _________________________________ Telephone # _________________
*Father’s Occupation: ________________________________________ Town: ______________________
*Mother’s Place of Employment: ________________________________ Telephone # __________________
*Mother’s Occupation: _______________________________________ Town: ______________________

*Name & age of brothers & sisters:
      Name                         Age                                 Name                    Age
__________________________________________                         ______________________________________
__________________________________________                         ______________________________________

Date Entered P.V.R.S. ________________________        Grade _________________________________
Previous school attended ____________________________________________________________________
                         Town ___________________________________________ State _______________

The above information is correct. _________________________________________                     __________________
                                    Parent/Guardian Signature                                    Date
PLEASE RETURN TO GUIDANCE OFFICE.
This information is for the student’s permanent record card and is kept on his/her transcript in our file for 60 years.
*Optional                                                                                                      (Over)
                               Home Language Survey
Dear Parents and Guardians:

In order to help your child succeed in school, we ask that you please answer the
following questions for each child in your family. Your answers will help us in creating
the best possible educational program for your child.

       1. What language did your child first understand or speak? _________________
       2. What language do you use most often when speaking with your child at
           home? ___________________
       3. What language does your child use most often when speaking with you at
           home? ___________________
       4. What language does your child use most often when speaking with other
           family members? ________________
       5. What language does your child use most often when speaking with friends?
           _________________________
       6. What language(s) does your child read? ______________________________
       7. What language(s) does your child write? ______________________________
       8. At what age did your child start attending school? ______________________
       9. Has your child attended school every year since that age? _____ Yes ____ No
          If no, please explain: _____________________________________________
       10. Would you prefer oral and written communication from the school in English
           or in your home language? _______________

____________________________________
Signature of Parent/Guardian
To be completed by ELL Program Staff Before Placement:
Date/School Enrollment: ________________________________
Student’s First Name: _________________ Student’s Family Name: ________________
Age of Student: ___________ Birth Date: _____________ Grade: __________________
Relationship of Person Completing Survey: _____Mother _____Father _____Guardian
                                          _____Other Specify: __________________
Number of Years Student in USA: ___________
Recommendation: ______Proficiency Testing/Records Review ______ No ELL Services
Signature of ELL Staff: ___________________________________________________
cc: Principal                                                   Home Language Survey
    ELL Services Coordinator                                      English Form
    Guidance Counselor

								
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