Great Oaks Academy Registration Form

Student Information
Student Legal Name*
First Middle Last
Please Check*
- Male
- Female
Date of Birth*
Month
Day
Year
Grade Applying For*
Primary Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Phone*
Primary Email*
With Whom Does the Student Reside?*
Relationship*
Please list other children living in the home
Name Birthdate Grade

* According to Minnesota statute 124.E11, a charter school shall give preference for enrollment to a sibling of an enrolled student and to a foster child of that parent and may give preference for enrolling children of the school’s teachers before accepting other students by lottery. For this purpose, we request that you list above all children who are currently enrolled have applied for enrollment at Great Oaks Academy.
Has your student been Preschool Screened?*
- Yes
- No
In what district was your student screened?*
Please call 651-460-3200 to schedule your screening. This is required for entrance into Kindergarten.
Legal Guardian #1
Name*
First Last
Relationship to student*
Include for Mailings?*
- Yes
- No
Address (if different than student)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone (if different from student)
Mobile Phone
Work Phone
Email
Legal Guardian #2 (if applicable)
Name
First Last
Relationship to student
Include for Mailings?
- Yes
- No
Address (if different from student)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone (if different from student)
Mobile Phone
Work Phone
Email
Emergency contact #1 - Other than Parent/Guardian
If your child becomes ill at school or if school closes for an emergency please list someone who can care for him/her if we are unable to reach parents/guardians.
Name*
First Last
Relationship*
Phone*
Emergency Contact #2- Other Than Parent/Guardians:
Name
First Last
Relationship
Phone
Please answer the following questions regarding the student
Was the student born in a country other that the United States?*
- Yes
- No
Country*
Date the student first entered the United States*
Month
Day
Year
Date the student first attended school in the United States*
Month
Day
Year
Racial Ethnic Information
The following data is collected for the purpose of compliance with federal and state civil rights laws. Parents/guardians or ageappropriate students are asked to identify student’s ethnicity and race.
Is the student Hispanic/Latino as defined by the federal government?*
- No, not Hispanic/Latino(a)
- Yes, Hispanic/Latino(a)
The federal definition includes persons of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
Select all that apply from the list below.
- Decline to indicate
- Colombian
- Ecuadorian
- Guatemalan
- Mexican
- Puerto Rican
- Savadoran
- Spaniard/Spanish/Spanish-American
- Other Hispanic/Latino
- Unknown
Does the student identify as American Indian or Alaska Native as defined by the state of Minnesota?*
- Yes
- No
The state of Minnesota definition includes persons having origins in any of the original peoples of North America who maintain cultural identification through tribal affiliation or community recognition. [This question is needed to calculate state aid/funding.]
Select all that apply from the list below.
- Decline to indicate
- Anishinaabe/Ojibwe
- Cherokee
- Dakota/Lakota
- Other North American Indian Tribal Affiliation
- Unknown
Is the student American Indian from South or Central America?*
- Yes
- No
Is the student Asian as defined by the federal government?*
- Yes
- No
The federal definition includes persons having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
Select all that apply from the list below.
- Decline to indicate
- Asian Indian
- Burmese
- Chinese
- Filipino
- Hmong
- Karen
- Korean
- Vietnamese
- Other Asian
- Unknown
Is the student black or African American as defined by the federal government?*
- Yes
- No
The federal definition includes persons having origins in any of the black racial groups of Africa.
Select all that apply from the list below.
- Decline to indicate
- African-American
- Ethiopian-Oromo
- Ethiopian-Other
- Liberian
- Nigerian
- Somali
- Other black
- Unknown
Is the student Native Hawaiian or Other Pacific Islander as defined by the federal government?*
- Yes
- No
The federal definition includes persons having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
Is the student white as defined by the federal government?*
- Yes
- No
The federal definition includes persons having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Homeless Status
This following information is used to ensure the educational rights and protection for students experiencing homelessness. A homeless individual is one who: (1) lacks a fixed, regular and adequate nighttime residence and(2) includes: (a) children and youths are sharing the housing of other persons due to loss of housing, economic hardship, or a similar reason; are living in motels, hotels, trailer parks, or camping grounds due to the lack of alternative adequate accommodations; are living in emergency or transitional shelter; are abandoned in hospitals; or are awaiting foster care placement; (b) children and youths who have a primary nighttime residence that is a public or private place not designated for or ordinarily used as a regular sleeping accommodation for human beings: and (c) children or youths who are living in cars, parks, public spaces, abandoned buildings, substandard housing, bus or train stations, or similar settings. You are not required to complete the information in this section of the form. If you choose not to complete this section there may be a delay in the provision of services. Teachers, school leaders, and the Minnesota Department of Education (MDE) will have access to this information.
Is the student considered homeless?*
- Yes
- No
What district and school did the student attend prior to becoming homeless?
Previous School Enrollment Information
School District Name*
School Name*
City/State*
Grade(s) Enrolled*
Withdraw Date*
Month
Day
Year
Special Services
Does the student have an IEP (Individualized Education Plan)?*
- Yes
- No
If yes, what is the student’s primary disability (if applicable) (Check all that apply)?*
- Autism Spectrum Disorders
- Developmental Cognitive Disability
- Developmental Delay
- Deaf/Hard of Hearing
- Emotional/Behavior Disorders
- Other Health Disorders
- Physically Impaired
- Specific Learning Disability
- Speech/Language Impairments
- Traumatic Brain Injury
- Visually Impaired
- Unknown
If your student’s disability was not listed above or if you feel more explanation is necessary at this time, please describe. Please feel free to include your student’s most recent IEP and evaluation with enrollment documents
Does the student have a 504 Education Plan?*
- Yes
- No
Please feel free to include your student’s most recent 504 Plan with enrollment documents.
Does your student currently receive ELL (English Language Learner) services?*
- Yes
- No
Is the student currently enrolled in a Gifted/Talented program?*
- Yes
- No
Has the student ever been expelled from a previous school?*
- Yes
- No
Digital Equity
Does the student use an electronic device like a computer, tablet or smart phone to complete homework?*
- No (Skip the next two questions)
- Yes (Continue to next question)
If yes, what type of electronic device does the student usually use to complete homework? (Please select only one)
- Desktop or Laptop
- Tablet
- Chromeboook
- Smart phone
- Other
Is the electronic device provided from the school?
- Yes
- No
Is the electronic device shared with anyone else in the home?
- Yes
- No
Internet Access
Can the student access the Internet on their electronic device at home?*
- No - Internet is not available at home
- No - Internet is not affordable at home
- No
- Yes (Continue to the next question)
If Yes to the above question what kind of internet service do you have at home?
- Residental broadband (e.g. Cable, Fiber, DSL)
- Cellular network
- School - provided hotspot
- Satellite
- Dial-up
- Other
- I am not sure.
Can the student stream a video on their electronic devices without pauses?
- Yes - with no pauses or buffering
- Yes - with some pauses or buffering
- No - streaming doesn't work
The information provided above is current and represents accurate information about the student.
Parent/Legal Guardian Printed Name*
Parent/Legal Guardian Signature*
NOTE TO PARENTS:
- In order to enroll for kindergarten, students must turn 5 on or before September 1 of enrollment year.
- Lottery will be conducted in accordance to our enrollment policy if applicable.
Great Oaks Academy will provide equal educational opportunity for all students and will not unlawfully discriminate on the basis of race, color, creed, religion, national origin, sex, marital status, parental status, status with regard to public assistance, disability, sexual orientation or age. Moreover, Great Oaks Academy also makes reasonable accommodations for students with disabilities.
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Great Oaks Academy Registration Form

Student Information

Legal Guardian #1

Legal Guardian #2 (if applicable)

Emergency contact #1 - Other than Parent/Guardian

Emergency Contact #2- Other Than Parent/Guardians:

Please answer the following questions regarding the student

Racial Ethnic Information

Homeless Status

Previous School Enrollment Information

Special Services

Digital Equity

Internet Access

The information provided above is current and represents accurate information about the student.

NOTE TO PARENTS:

115 Elm St Farmington, MN 55024

info@greatoaksacademymn.com

651-615-0499

651-615-5575

Name	Birthdate	Grade