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Ready For Learning Plan 20-21
4.01.1 - The school-level improvement plans, including the literacy plan required by Ark. Cod Ann. §6-15-2914(b)
4.01.2 - The written discipline policies
4.01.3 - All student handbooks
4.01.4 - The school calendar
4.01.5 - The written bullying policies adopted in accordance with Ark. Code Ann. §6-18-514
4.01.6 - The comprehensive school counseling plan as required by Ark. Code Ann. §6-18-2005
4.01.7 - The plan for parent, family, and community engagement and informational packets required by Ark. Code Ann. §6-15-1702
4.02 - Annual School Performance Reports
4.03 - Level 4-Directed District Support Plan as required by Ark. Code Ann. §6-15-2914
4.05 - Vaccination and Immunization Report as required by Ark. Code Ann. §6-18-702(b)
4.06 - Waivers granted under Ark. Code Ann. §6-15-103
5.01.1 - Written policies for the fiscal operation of the district
5.01.2.1 - Local and State revenue sources
5.01.2.2 - Administrator and teacher salary and benefit expenditure data
5.01.2.3 - School District balances, including legal balances and building fund balances
5.01.2.4 - The district budget for the current year
5.01.3 - A financial breakdown of monthly expenses of the district
5.01.4 - Salary schedules for all employees, including extended contract and supplementary pay amounts
5.01.5 - All current contract information with all district employees
5.01.6 - The annual school district statistical report
6.01 - District licensed and classified personnel policies and salary schedules required under Ark. Code Ann. §6-17-201 et deq. and Ark. Code Ann. §6-17-2301 et seq.
7.01 - District screening result as required under Ark. Code Ann. §6-41-603
7.02.1/7.02.2/7.02.3 - During previous school year: The dyslexia intervention programs used; The number of students who received dyslexia intervention; and The total number of students who were identified with dyslexia.
8.01 - Accreditation Status of the School District
9.01/9.02 - Dates, times, and location of school board meetings
9.03 - School Board Minutes
2020-2021 School Board Minutes
2019-2020 School Board Minutes
2018-2019 School Board Minutes
2017-2018 School Board Minutes
2016-2017 School Board Minutes
Faculty/Staff
Certified Personnel Policy Handbook
Classified Personnel Policy Handbook
Forms
Absence Request Form
Change of Address Form
District Expense Reimbursement
Employee Internet Use Agreement Form
Inventory Movement/Deletion Form
Professional Development Request
Purchase Request Form
Technology Request
School Dude
Travel Reimbursement
Parents/Students
Information on Grab & Go Meals for Virtual Students
Elementary Registration Form
High School Registration Form
Elementary Student Handbook
High School Student Handbook
Immunization Requirements
School Choice
Wellness Policy/Plan on Physical Activity and Nutrition
Transcript Request
Elementary School Improvement Plan
High School Improvement Plan
Departments
ESports Team
EAST
Elementary Counselor's Corner
Band
Cafeteria
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MINERAL SPRINGS
School District
School District
Parents/Students
High School Registration Form
High School Registration Form
Please Fill Out The High School Registration Form Below
How will your child ATTEND SCHOOL for the 2020-2021 School Year?
My child will attend school VIRTUALLY/ONLINE
My child will attend school Face-to-Face
Student's First Name:
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Student's Middle Name:
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Student's Last Name:
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Student's Nickname:
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Student's Birthdate
Calendar
Student's SSN:
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Gender:
Male
Female
Grade:
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
PRIMARY RACE
Select One
AMERICAN INDIAN or ALASKA NATIVE - A person having origins in any of the original peoples of North and South America, including Central America, and who maintains tribal affiliation or community attachment
ASIAN - A person having origins in any of the original peoples of Far East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, Chine, India, Japan, Korea, Malaysia, Pakistan, the Philippine Isalnds, Thailand and Vietnam
BLACK or AFRICAN AMERICAN - A person having origins in any of the black racial groups of Africa
NATIVE HAWAIIAN or OTHER PACIFIC ISLANDER - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
WHITE - A person having origins in any of the original peoples of Europe, Middle East or North Africa
Hispanic/Latino Ethnicity:
Yes
No
Additional Races:
American Indian/Alaska Native
Asian
Black
Native Hawaiian/Other Pacific Islander
White
Language Spoken at Home?
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Student Home Phone:
Student Cell Phone:
Student Email Address:
Student Physical/911 Address
Address
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City
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State / Province / Region
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Zipcode
Min: 1 Max: 5
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Country
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia-Herzegovina
Botswana
Bouvet Island
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Caymen Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling Islands)
Colombia
Comboros
Congo, Democratic Republic of the (Zaire)
Congo, Republic Of
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
Gaon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe (French)
Guam (USA)
Guatemala
Guinea
Guinea Bissau
Guyana
Haiti
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast (Cote D'lvoire)
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique (French)
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia (French)
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Polynesia (French)
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste (East Timor)
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands
Wallis and Futuna Islands
Yemen
Zambia
Student Mailing Address
Address
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City
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State / Province / Region
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Zipcode
Min: 1 Max: 5
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Country
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia-Herzegovina
Botswana
Bouvet Island
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Caymen Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling Islands)
Colombia
Comboros
Congo, Democratic Republic of the (Zaire)
Congo, Republic Of
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
Gaon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe (French)
Guam (USA)
Guatemala
Guinea
Guinea Bissau
Guyana
Haiti
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast (Cote D'lvoire)
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique (French)
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia (French)
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Polynesia (French)
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste (East Timor)
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands
Wallis and Futuna Islands
Yemen
Zambia
PARENT/GUARDIAN #1
FIRST NAME:
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LAST NAME:
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Relationship to Student:
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Language of Correspondence:
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Mailing Address:
Address
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City
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State / Province / Region
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Zipcode
Min: 1 Max: 5
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Country
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia-Herzegovina
Botswana
Bouvet Island
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Caymen Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling Islands)
Colombia
Comboros
Congo, Democratic Republic of the (Zaire)
Congo, Republic Of
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
Gaon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe (French)
Guam (USA)
Guatemala
Guinea
Guinea Bissau
Guyana
Haiti
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast (Cote D'lvoire)
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique (French)
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia (French)
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Polynesia (French)
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste (East Timor)
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands
Wallis and Futuna Islands
Yemen
Zambia
Email Address:
Home Phone:
Cell Phone:
Alert Phone:
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Work Phone:
Employer:
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PARENT/GUARDIAN #2
FIRST NAME:
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LAST NAME:
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Relationship to Student:
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Language of Correspondence:
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Mailing Address:
Address
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City
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State / Province / Region
Tooltip
Zipcode
Min: 1 Max: 5
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Country
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia-Herzegovina
Botswana
Bouvet Island
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Caymen Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling Islands)
Colombia
Comboros
Congo, Democratic Republic of the (Zaire)
Congo, Republic Of
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
Gaon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe (French)
Guam (USA)
Guatemala
Guinea
Guinea Bissau
Guyana
Haiti
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast (Cote D'lvoire)
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique (French)
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia (French)
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Polynesia (French)
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste (East Timor)
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands
Wallis and Futuna Islands
Yemen
Zambia
Email:
Home Phone:
Cell Phone:
Alert Phone:
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Work Phone:
Employer:
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Student Primarily Resides With:
Parent/Guardian #1
Parent/Guardian #2
Both
Student's City of Birth:
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Student's State of Birth:
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Student's Birth Country:
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Student travels TO school by:
Bus
Drives Self
Parent/Guardian (includes walkers, child care vans, etc.)
District Paid Transportation
Student travels FROM school by:
Bus
Drives Self
Parent/Guardian (includes walkers, child care vans, etc.)
District Paid Transportation
If your student travels by bus, what is the bus number?
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What is the distance from Home to School (Miles) one way?
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Pre-School Participation (if applicable)
A-Arkansas Better Chance
E-Even Start
EC-Early Childhood
H-Headstart
NA-Not Applicable
C-21st Century Community Learning Center
O-other
P-Private Pre-School
PS-Public School Pre-School
Student's Birth Certificate Number:
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Student's Resident County:
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Is this child a dependent of an active or reserve member of a branch of the United States Armed Services?
Yes
No
If this child resides in a household with an active or reserve member of a branch of the United States Armed Services, please select the branch below.
Active Duty-US Army
Reserves-US Army
Active Duty-US Navy
Reserves-US Navy
Active Duty- US Air Force
Reserves-US Air Force
Active Duty-US Marines
Reserves-US Marines
Active Duty-US Coast Guard
National Guard-US Army
National Guard-US Air Force
Parents serve in multiple branches
Is this student a twin (or a triplet, quadruplet, etc.)?
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ADDITIONAL GUARDIAN/CONTACT
FIRST NAME:
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LAST NAME:
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Relationship to Student:
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Language of Correspondence:
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Email:
Mailing Address:
Address
Tooltip
City
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State / Province / Region
Tooltip
Zipcode
Min: 1 Max: 5
Tooltip
Country
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia-Herzegovina
Botswana
Bouvet Island
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Caymen Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling Islands)
Colombia
Comboros
Congo, Democratic Republic of the (Zaire)
Congo, Republic Of
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
Gaon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe (French)
Guam (USA)
Guatemala
Guinea
Guinea Bissau
Guyana
Haiti
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast (Cote D'lvoire)
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique (French)
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia (French)
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Polynesia (French)
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste (East Timor)
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
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Ukraine
United Arab Emirates
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United States
Uruguay
Uzbekistan
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Venezuela
Vietnam
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Wallis and Futuna Islands
Yemen
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Home Phone:
Cell Phone:
Alert Phone:
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Work Phone:
Employer:
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Does student reside with this Additional Guardian/Contact?
Yes
No
EMERGENCY Contact #1 Name:
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Relationship to Student:
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Language of Correspondence
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Phone:
Type of Phone?
Home
Cell
Work
Other
Other
EMERGENCY Contact #2 Name:
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Relationship to Student?
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Language of Correspondence
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Phone:
Type of Phone?
Home
Cell
Work
Other
Other
EMERGENCY Contact #3 Name:
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Relationship to Student:
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Language of Correspondence
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Phone:
Type of Phone:
Home
Cell
Work
Other
Other
Student's Physician:
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Physician's Phone Number:
Please list any medical conditions, concerns, and/or medications for your child.
Last School Attended:
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Address/Phone of Last School Attended:
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Has this child been retained?
Yes
No
Has this child met the requirements of the Arkansas State Health laws necessary to enter school?
Yes
No
Please list the names of anyone who IS ALLOWED to check out/pick up this child from school:
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Parent/Guardian Signature
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Date of Submission:
Calendar
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