STUDENT REGISTRATION OFFICE

www.cornwallschools.com

Welcome to the Cornwall Central School District!

Attached is the Cornwall Central School District enrollment packet for you to complete. (One per child)

Along with this packet, the following documents are required at time of registration:

 Online Pre Registration – must be completed prior to submitting any registration paperwork.

Please visit the link below to create a new student account (top left of page)

https://st-cw.mhric.org/Cornwall/onlinepreregistration/

 Proof of residency:

- If you own your home, provide a current tax bill OR a current mortgage statement AND a current utility bill.

- If you rent your home, provide a current lease AND a current utility bill.

- If you are residing with family, please call the Registrar for a CCSD Resident Affidavit.

 Birth Certificate (the registrar will make a copy)

 Most recent report card

 Immunizations up-to-this date

 Your child will need a physical completed in New York State within the year of starting school.

Your child has 15 days after his/her first day of school to provide a NYS physical to the school nurse.

If you have any questions, do not hesitate to call or email me.

Crystal O’Brien

Central Registrar

Cornwall Central High School

10 Dragon Drive

New Windsor, NY 12553

Phone: 845-534-8009 x7803

[email protected]

CORNWALL CENTRAL SCHOOL DISTRICT

ENROLLED STUDENT INFORMATION FORM

STUDENT’S NAME: ___________________________________________ GRADE: _____________

First Middle Last

DATE OF BIRTH: __________________________________ GENDER: Male Female

PLACE OF BIRTH: __________________________________

City & State / Country if not USA

DATE OF ENTRY INTO THE USA: _________________ YEARS IN USA SCHOOLS: _______

IS EITHER PARENT OR LEGAL GUARDIAN AN ACTIVE DUTY MEMBER OF THE ARMED

FORCES? IF YES, PLEASE SPECIFY BELOW:

Name: _____________________ Branch of Service:_____________ Entry Date:__________ Exit Date: __________

ETHNICITY: Yes, Hispanic/Latino No, Not Hispanic/Latino

Hispanic, Latino, or of Spanish origin means a person of Cuban, Mexican, Puerto Rican,

Central or South America, or other Spanish culture or origin, regardless of race.

RACE: You may choose one or more

Am Indian/Alaska Native - A person having origins in North America and who maintains cultural identification

through tribal affiliation or community recognition. e.g. Cherokee, Mohawk, Inuit.

Asian - A person having origins in any of the origins of the Far East, Southeast Asia, or the Indian subcontinent.

Native Hawaiian/Pacific Islander - A person having origins in Hawaii, Guam, Samoa, or other Pacific Islands.

Black/African American - A person having origins in any of the Black racial groups of Africa.

White - A person having origins in Europe, North Africa or the Middle East.

_____________________________________________ ______________________

Signature of Parent / Guardian Date

*This information is gathered pursuant to New York State and Federal requirements, but is not used to

make a determination with respect to a student’s right to register and enroll in the Cornwall Central

School District.

CORNWALL CENTRAL SCHOOL DISTRICT

STUDENT REGISTRATION OFFICE – 10 DRAGON DRIVE, NEW WINDSOR, NY 12553

PHONE: 845-534-8009 x7803

STUDENT’S NAME ___________________________________________________ GENDER: MALE  FEMALE  GRADE: _________

First Middle Last

DATE OF BIRTH: ________________________

PARENT MARITAL STATUS __________________ Is there a custody issue with this child? ________ If yes, who has custody? _______________

ORDER OF PROTECTION _____ If an order of protection exists, please submit a copy to your child’s principal at time of student enrollment.

SIBLINGS RESIDING AT HOME

NAME OF SIBLING

DATE OF BIRTH

GRADE

SCHOOL ATTENDING

STUDENT’S EDUCATIONAL BACKGROUND

SCHOOL NAME

CITY/STATE

ATTTENDED: GRADE / YEAR

Has your child been retained (repeated a grade)?  Yes  No If yes, what grade? _____________

Has your child received:  Counseling  Speech  Remedial Math  Remedial Reading  Other ___________________

Does your child have an Individual Education Plan (IEP)? Yes ________ No _______ At what were services provided? __________

EMERGENCY CONTACTS: Local person who have agreed to care for your child in an emergency when parents cannot be reached:

In an emergency situation, Administration will take any action it deems necessary and appropriate, including taking your child to the hospital.

#1____________________________________________ _______________________ _______________________

Name Relationship to child City/State (MUST BE LOCAL)

__________________ ______________________ _______________________ _______________________

Home Phone # Cell Phone #1 Cell Phone #2 Work Phone #

#2_____________________________________________ _______________________ _______________________

Name Relationship to child City/State (MUST BE LOCAL)

__________________ ________________________ ________________________ _______________________

Home Phone # Cell Phone #1 Cell Phone #2 Work Phone #

________________________________ ______________________________ ___________________

Signature of Parent, Guardian Relationship Date

_____ Check here (and provide details) if student lives in a shelter, abandoned apartment/building, motel/hotel, camp ground, car, or train/bus station; if the

student lives with relatives or others due to lack of housing or other similar situation; or if the student is temporarily housed in a shelter awaiting permanent foster

care placement__________________________________ (living arrangements). If box is checked, please complete STAC-202 form. The answer you give will help

the district determine what services you or your child may be able to receive under the McKinney-Vento Act. Students who are protected under the McKinney-

Vento Act are entitled to immediate enrollment in school even if they do not have the documents normally needed, such as; proof of residency, school records,

immunization records or birth certificate. Students who are protected under the McKinney-Vento Act may also be entitled to free transportation and other services.

Is this a foster placement: _____ Yes ______ No If yes, name of county: _____________________________________

If yes, copy of DSS 2999 Form required

Cornwall Central School District

COMPUTER USE AND PHOTO PERMISSION FORM

Cornwall Central School District wishes to provide students, educators and community with a useful computer

information system. Our computer network, e-mail system, internet access policy and district website serve to help

our staff and students conduct research, produce material and communicate. All Students have access to this system.

Abuse or misuse of the computer system may subject a student to have use rights removed as per the Code-of-Conduct.

To highlight the accomplishments and or engagement of our students, there are often occasions when a building

administrator or teacher will want to publish photographs and/or videos of students engaged in school-related

activities while on School District property or at School District sponsored functions to the School District’s website or

to select social media sites monitored and edited by the School District such as Facebook or Twitter. Student’s name

will not be included.

If you do not want the District to use your child’s image or likeness on the District’s website or sponsored social media

sites, please sign and return the slip below.

If you have any questions or concerns, please contact your child’s principal.

_________ NO, I do not want my child’s picture to be posted on the School

District’s website, district sponsored social media forums i.e., Facebook, Twitter

_________ YES, I give CCSD permission to post my child’s picture.

_______________________________ __________ _______________

CHILD’S NAME BUILDING DATE

_______________________________ ______________________________

PRINT PARENT / GUARDIAN’S NAME PARENT / GUARDIAN SIGNATURE

STATE EDUCATION DEPARTMENT

/ THE UNIVERSITY

OF THE STATE OF

NEW YORK / ALBANY, NY

12234

Elisa Alvarez, Associate Commissioner Office of Bilingual Education and World Languages

55 Hanson Place, Room 594

89 Washington Avenue, Room 528EB

Brooklyn, New York 11217

Albany, New York 12234

Tel: (718) 722-2445 / Fax: (718) 722-2459

(518) 474-8775 / Fax: (518) 474-7948

Home

Language

Questionnaire

(HLQ)

H

O M E

L

A N G U A G E

C

OD E

Language Background

(Please check all

that

apply.)

1. What language(s) is(are) spoken in the student’s home

or residence?



English



Other

specify

2.

What

was the

first

language your

child

learned?



English



Other

specify

3. What

is

the

Home

Language

of

each

parent/guardian?



Parent

1



Guardian(s)



Parent

2

specify

4. What

language(s)

does

your child

understand?



English



Other

specify

5.

What

language(s)

does

your child

speak?



English



Other

specify



Does not

speak

6. What

language(s) does

your child

read?



English



Other

specify



Does not read

7.

What

language(s) does

your child

write?



English



Other



Does not write

specify

S

C H O O L

D

I S T R I C T

I

N F O R M A T I O N

:

S

T U D E N T

I D

N

U M B E R

I N

NY S

S

T U D E N T

I

N

F

O

R

M

A

T

I

O

N

S

Y

S

T

E

M

:

District Name (Number)

& School:

Address:

S

T U D E N T

N

A M E

:

First

Middle

Last

D

A T E

O F

B

I R T H

:

G

END E R

:



Male



Female

Month

Day

Year

P

A R E N T

/ P

E R S O N

I N

P

A R E N T A L

R

E L A T I O N

I

N F O

:

Last

Name

First

Name

Relation

to

Dear Parent or Person in Parental Relation:

In order to provide your child with the best

possible education, we need to determine

how well he or she understands, speaks,

reads and writes in English, as well as prior

school and personal history. Please

complete the sections below entitled

Language Background and Educational

History. Your assistance in answering these

questions is greatly appreciated.

Thank you.

Home Language Questionnaire (HLQ)—Page Two

_____________________________________________________ Month: Day: Year:____

Signature

of

Parent

or

of

Person

in

Parental

Relation

Date

Relationship to student:



Parent



Other:

Educational

History

8.

Indicate

the total

number

of years

that

your child

has

been enrolled

in

school

9. Do you think your child may have any difficulties or conditions that affect his or her ability to understand, speak, read or write in

English or any other language?

If yes, please describe them.

Yes*

No

Not

sure



*

If yes,

please explain:

How

severe

do

you

think

these

difficulties

are?



Minor



Somewhat

severe



Very severe

10a.

Has

your

child

ever

been

referred

for

a

special

education

evaluation

in

the

past?



No



Yes*

*Please

complete

10b

below

10b.

*If

referred

for

an

evaluation,

has

your

child

ever

received

any

special

education

services

in

the

past?



No



Yes – Type of services received:

Age at

which

services

received

(Please

check

all

that apply):



Birth

to

3

years

(Early

Intervention)



3

to

5

years

(Special

Education)



6

years

or

older

(Special

Education)

10c.

Does

your

child

have

an

Individualized

Education

Program

(IEP)?



No



Yes

11.

Is

there

anything

else

you

think

is

important

for

the

school to

know

about

your

child?

(e.g.,

special

talents,

health

concerns,

etc.)

12.

In

what

language(s)

would

you

like

to

receive

information

from

the

school?

OFFICIAL ENTRY ONLY - NAME/POSITION OF PERSONNEL ADMINISTERING HLQ

N

AME

:

P

OSITION

:

I

F AN

INTERPRETER

IS

PROVIDED

,

LIST

NAME

,

POSITION AND CREDENTIALS

:

NAME/POSITION OF QUALIFIED PERSONNEL REVIEWING HLQ AND CONDUCTING INDIVIDUAL INTERVIEW

N

AME

:

P

OSITION

:

O

RAL

I

NTERVIEW

N

ECESSARY

:



N

O



Y

ES

**D

ATE OF

I

NDIVIDUAL

I

NTERVIEW

:

O

UTCOME OF

I

NDIVIDUAL

I

NTERVIEW

:



A

DMINISTER

NYSITELL





E

NGLISH

P

ROFICIENT





R

EFER

TO

L

ANGUAGE

P

ROFICIENCY

T

EAM



M

O

D

AY

YR

.

N

AME

:

NAME/POSITION OF QUALIFIED PERSONNEL ADMINISTERING NYSITELL

P

OSITION

:

D

ATE OF

NYSITELL

ADMINISTRATION:

P

ROFICIENCY

L

EVEL

A

CHIEVED ON

NYSITELL:



E

NTERING



E

MERGING



T

RANSITIONING



E

XPANDING



C

OMMANDING

M

O

.

FOR

STUDENTS

WITH

DISABIL

D

AY

ITIES,

YR

.

LIST

ACCOMMODATIONS,

IF

ANY

, ADMINISTERED

IN ACCORDANCE

WITH IEP PURSUANT

TO CSE RECOM

MENDATION:



CORNWALL CENTRAL SCHOOL DISTRICT

SCHOOL TRANSPORTATION REQUEST FORM – PUBLIC SCHOOL

Today’s Date:

SCHOOL YEAR: START DATE:

Student’s Name:

First Middle Last

DOB: Gender: M F

Home Address:

(Street address, city, state, zip code)

Mailing Address (if different from above):

(Street address, city, state, zip code)

Parent/ Guardian Name(s):

Home Phone: Cell/Work: ___________________________________________

Email:

School: HS MS CES WAE COH Grade: ______________________



NEW STUDENT NEW ADDRESS (SEE BELOW) NEW CHILDCARE CHANGE IN SCHOOL



OTHER (please explain):

CHANGE OF ADDRESS WILL REQUIRE PROOF OF RESIDENCY AND MUST BE PRESENTED TO:

Central Registrar, Crystal O'Brien PH: 845-534-8009 x7803 Email address: cobrien@cornwallschools.com

REQUEST:

Transportation to/from HOME address.

Transportation with CHILDCARE arrangements.

WALKER/PARENT TRANSPORT - transportation not required.

Does your child have any medical concerns we should know about, ie, allergies, etc.? Please explain:

Parent Signature: Date:

Return to: Transportation Coordinator

PH: 845-534-8009 x7100 FAX: 845-534-9032 Email address: transportation@cornwallschools.com** PLEASE NOTE

TRANSPORTATION CHANGES TAKE APPROX 48 HOURS or longer during the first week of school**

CHILDCARE TRANSPORTATION (within CCSD)

A.M. PICK UP:

P.M. DROP OFF:

Check: Home Childcare Provider Walker

Providers Name:

Providers Address:

Providers Phone:

Days:

Mon

Tues

Wed

Thurs

Fri

Days:

Mon

Tues

Wed

Thurs.

Fri

FOR OFFICE USE ONLY: NEW STUDENT: (YES OR NO) STUDENT ID#: Parent Notified:

BUS RUN #: A.M. P/U TIME: Location: P.M. D/O TIME: Location:

Cornwall Central School District

STUDENT HEALTH OFFICES

(845) 534-8009

High School Middle School Cornwall on Hudson Elementary Cornwall Elementary Willow Avenue Elementary

Ext. 5010 Ext. 4010 Ext. 1010 Ext. 2010 Ext. 3010

Student’s Name: __________________________________________________________Gender: _______ Date of Birth: _________________

Parent email: _____________________________________________________________________ Grade: _______________

Home Address: ___________________________________________________________________ Home phone #: ____________________

Parent/Guardian: ________________________________________Cell #:________________________ Work #:_______________________

Parent/Guardian: ________________________________________ Cell #:_______________________ Work#: _______________________

__________________________________________________________________________________________________________________

Student’s Medical History

Has your child ever had the following Communicable Diseases:

Yes No Date Yes No Date

Chicken Pox ____ ____ _________ Scarlet Fever ____ ____ ________

Mumps ____ ____ _________ Whooping Cough ____ ____ ________

German Measles ____ ____ _________

1) Is your child presently under treatment for any physical problem? Yes_______ No_______

If so, explain: _______________________________________________________________________________________________

2) Does your child take medication on a regular basis? Yes_______ No________

If so, name of medication and reason____________________________________________________________________________

If your child needs to take medication during the school day, you must contact the Health office in person.

Specific forms must be filled out and signed by your Physician before ANY medication can be administered.

3) Has your child ever had surgery? Yes_____ No_______ Explain: __________________________________________________

4) Has your child had any serious medical problems? Yes_____ No_____ Explain: ________________________________________

5) Has your child had a serious accident or injury? Yes_____ No_____ Explain: _________________________________________

6) Has your child ever been hospitalized? Yes_____ No_____ Explain: ________________________________________________

7) Does your child have any allergies to food, medication or insects/bee stings? Yes_______ No_______

If yes, please list: ____________________________________________________________________________________________

8) Does your child wear glasses or contacts? Yes_____ No_____ Other visual difficulties, please explain:

___________________________________________________________________________________________________________

9) Does your child have any: Ear problems? Yes_____ No_____

Hearing loss? Yes_____ No_____

Frequent ear infections? Yes_____ No_____

Tubes in ears? Yes_____ No_____ At what age? ______________

Explain: _______________________________________________________________________________________________________

10) Does your child have any speech difficulties? Yes_____ No_____ If yes, please explain: ______________________________

_____________________________________________________________________________________________________________

11) Does your family have any history of diabetes or tuberculosis? Yes_________ No________

Family Physician: ______________________________________________________________________________________________

Name City/State Phone #

In emergency situations, Administration will take any action it deems necessary & appropriate, including taking your child to the

hospital.

Parent / Guardian Signature: ________________________________________________________Date:_________________

CORNWALL CENTRAL SCHOOL DISTRICT - CORNWALL, NY

** REQUEST FOR STUDENT RECORDS **

District Phone Number (845) 534-8009

PRIOR SCHOOL: ___________________________________________________

Address: _________________________________________________________

City, State, Zip: ____________________________________________________

Phone: _________________________ Fax: _________________________

Student’s Name: ________________________ Student’s DOB: _____________

The above named student has enrolled in the Cornwall Central School District.

Please forward to us the items listed below and any other pertinent information which

will assist us in placing and supporting this student. Thank you.

 Official Transcript

 Health / Immunization Records

 Standardized Test Scores

 School Profile

 Course Selections/Recommendations

for the new school year

 Discipline Records

 RCT Scores

 Copy of last Report Card

 Graduation Requirements

 Withdrawal Grades for current year

 Copy of I E P

 Behavior Intervention Plan or 504

 Psychological Reports (if any)

 Speech Evaluations (if any)

 OT / PT Evaluations (if any)

 Vision Evaluation (if any)

 Other:________________________

Please send records listed above to the attention of ________________________

_____Cornwall Central High School _____ Cornwall Elementary School

10 Dragon Drive 99 Lee Road

New Windsor, NY 12553 Cornwall, NY 12518

Fax: 845-565-4931 Fax: 845-534-0569

Email: [email protected]

_____Cornwall Central Middle School _____ Willow Avenue Elementary School

122 Main Street 67 Willow Avenue

Cornwall, NY 12518 Cornwall, NY 12518

Email: amilani@cornwallschools.com Fax: 845-314-9424

_____Cornwall on Hudson Elem. School _____ Office of Pupil Personnel Services

234 Hudson Street 10 Dragon Drive

Cornwall on Hudson, NY 12520 New Windsor, NY 12553

Fax: 845-534-2284 Fax: 845-314-8640

Email: [email protected]

I hereby authorize the release of the records listed above.

___________________________ ___________________________________ _____________

Signature of Student (if over 18) Signature of Parent / Guardian Date

Cornwall Central School District

Terry Dade

Superintendent of Schools

Harvey Sotland

Assistant Superintendent for Business

Megan Argenio

Assistant Superintendent for Instruction

THIS FORM MUST BE RETURNED WITH PHOTO IDENTIFICATION

Dear Parent / Guardian:

The Cornwall Central School District is introducing the Parent Portal of our SchoolTool Student Management Information

System to Parents/Guardians. You will have access to view the following information for your child: emergency contact

information, schedule, attendance, report card grades including progress reports, past assessment scores/past exam

grades.

To create an account for viewing this information, please complete the bottom portion of this letter and either bring it

to the main office of your child’s school or return the form to school with a copy of your current photo ID with your

child. Once the form is received at the school and processed, an account will be created. You will receive an email with

your first SchoolTool password and instructions on how to access your portal account. Please note that this process only

needs to be completed once, not every year. One form will cover all children in your family. SchoolTool is a secure

internet site; however, parents/guardians are responsible for protecting their password.

If you have any questions or concerns, please contact the main office your child’s building.

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Please keep top portion of this letter for your records.

Parents/Guardians must provide valid picture identification. Accounts will not be created without proper identification.

Name of Parent/Guardian: ______________________________________________________________

Parent/Guardian email address: _________________________________________________________

PLEASE PRINT LEGIBLY

Name of child(ren):

______________________________________ ______________________________________

Child’s name Grade/School Child’s name Grade/School

______________________________________ ______________________________________

Child’s name Grade/School Child’s name Grade/School

Signature of Parent/Guardian: ________________________________________________

BUILDING VERIFICATION

Type of Photo ID: ____________________ Date: ________ Date form received: ______________

Photo ID received by: ______________________________ Date account created: ____________