IIGP Student Registration – Instant Impact Global Prep

Instant Impact Global Prep Student Registration for the 23-24 School Year

Welcome to Instant Impact Global Prep Charter School

The following documents are required when registering a child to attend Instant Impact Global Prep (IIGP) School.

_____Social Security Card

_____Photo ID (Drivers license, state ID, or Passport)

_____Two Proofs of Residency (Ex. utility bill, property tax bill, lease agreement, and etc...)

______Birth Certificate or Passport (Supported file type: jpg, jpeg, jpe, png, gif, docx, pdf)

_____ Child's Immunization Record

_____Child's Most Recent Report Card (not required for Kindergarten)

_____ Signature of parent (Supported file type: jpg, jpeg, jpe, png, gif)

School Information

School Name

School Code

School Year

Today's Date

Student Information

Name

Entering Grade Level

Gender

Male

Female

Social Security Number

Address

Phone

Unlisted

Yes

Is student Hispanic or Latino?

Yes

Race/Ethnic Code

(Must check all that apply.)

Student's Birthplace (City):

Student's Birthplace (State):

Student's Birthplace (Country)

Student's Birthdate

Birth Document Source

(birth certificate, passport, etc.; provide document)

Nationality

Date student was enrolled in U. S. schools:

Has student ever received English as a Second Language (ESL) or Bilingual services?

Yes

Is student a Foreign Exchange student?

Yes

If Yes, enter 1-94 number:

Instant Impact Global Prep Schools is required to identify students whose parent is (or parents are) in the U.S. Armed Forces (Active Duty or Reserve status) or in the National Guard.

Parent/Guardian in U.S. Military or National Guard?

Yes

Parent's/Guardian's Name:

Parent or Gurdian

Parent

Gurdian

Parent's/Guardian's Resident School District

Enrollment Reasons (Check One)

From out of state / out of country

From home school in MS

From nonpublic school in MS

From an MS public district or charter (community) school

First time in MS public school due to age

Emergency Contacts

Name

Relationship to Student

Phone

Cell Phone

Primary Care Doctor & Phone

Language

A completed language usage survey is required for all students upon enrollment in Mississippi schools. This information will tell school staff if they need to check your child's proficiency in English. Answers to these questions ensure your child receives the education services to succeed in school. The information is not used to identify immigration status.

Communication Preferences

Indicate your language preference so we can provide an interpreter or translated documents at no cost when you need them. All parents have the right to information about their child's education in a language they understand.

In what language(s) would your family prefer to communicate with the school?

Language Background

Information about your child's language background helps us identify students who qualify for support to develop the language skills necessary for success in school. Testing may be necessary to determine if language supports are needed.

What language does this student speak most frequently? (Primary language)

What language is most often spoken by adults at home? (Home language)

What was this student's first language? (First language)

Prior Education

List student's previous schools, beginning with most recent school, including preschool:

School Name-1

Address (School-1)

Grades (School-1)

Date from (Sch-1)

Date to (Sch-1)

School Name-2

Address (School-2)

Grades (School-2)

Date from (Sch-1)

Date to (Sch-2)

Preschool Experience (Check all that apply.)

Kindergarten Experience

Half day

All Day

Siblings

Name (Sibling-1)

Gender (Sibling-1)

Male

Female

School Attending (Sibling-1)

Grade (Sibling-1)

Age (Sibling-1)

Name (Sibling-2)

Gender (Sibling-2)

Male

Female

School Attending (Sibling-2)

Grade (Sibling-2)

Age (Sibling-2)

Name (Sibling-3)

Gender (Sibling-3)

Male

Female

School Attending (Sibling-3)

Grade (Sibling-3)

Age (Sibling-3)

Parent Information

Name

Marital Status

If you check Separated or Divorced, we require current legal documentation related to the children.

Deceased?

Yes

District of Residence

District of Primary Residence

Resides with Student?

Yes

Address

Phone

Unlisted?

Yes

Cell Phone

Email Address

Employer

Work Address

Work Phone

Custodial Parent?

Yes

Legal Guardian?

Yes

Grandparent POA?

Yes

Caregiver Authorization?

Yes

Migrant Worker?

Yes

Receive School Mail (if not Custodial Parent)?

Yes

Name (P-2)

Marital Status (P-2)

If you check Separated or Divorced, we require current legal documentation related to the children.

Deceased? (P-2)

Yes

District of Residence (P-2)

District of Primary Residence (P-2)

Resides with Student? (P-2)

Yes

Address (P-2)

Phone (P-2)

Unlisted? (P-2)

Yes

Cell Phone (P-2)

Email Address (P-2)

Employer (P-2)

Work Address (P-2)

Work Phone (P-2)

Custodial Parent? (P-2)

Yes

Legal Guardian? (P-2)

Yes

Grandparent POA? (P-2)

Yes

Caregiver Authorization? (P-2)

Yes

Migrant Worker? (P-2)

Yes

Receive School Mail (if not Custodial Parent)? (P-2)

Yes

Students With Special Needs

Does child require mobility assistance? i.e. wheelchair, etc.)

Yes

Did child receive Special Education and related services in most recent school?

Yes

Does this child have a current IEP (Individualized Education Program)?

Yes

Does child have a 504 Accommodation Plan?

Yes

Did child receive Gifted services in most recent school?

Yes

Temporary Living Arrangements

Answers to these questions will help determine what services the student may be eligible to receive.

Is student's current address a temporary living arrangement?

Yes

No Is this temporary living arrangement due to loss of housing or economic hardship?

Yes

If answer to both of these questions is Yes, the student is entitled to immediate enrollment.

Where is the student living now?

In a motel or hotel

Doubled up with family or friend

In a homeless shelter

Unaccompanied youth

Other (a place not designed for ordinary sleeping accommodations)Other (a place not designed for ordinary sleeping accommodations)

Understanding Statement

I understand that any inaccurate information provided about this student on any page of this Student Registration Information Form may result in a change of grade level, a change of class, or an immediate transfer or withdrawal from this school.

Signature

Maximum upload size: 5MB

Supported file type: jpg, jpeg, jpe, png, gif

Date of signature

Request to Restrict Privacy Information

Federal and MS laws prohibit Instant Impact Global Prep School (IIGP) from publicly releasing information about our students, except for designated "Directory Information." Per Board Policy No. 8330, IIGP defines Directory Information as the following:

A student's name, school, grade level, parent-guardian's name, home address, telephone number, email address, participation in officially recognized activities and sports, and awards received Under MS public records law, IIGP is required upon request to provide the above Directory Information to any member of the public who requests it. IIGP' primary purpose for releasing Directory Information is to highlight students' accomplishments.

Parents, legal guardians, or students age 18 or over may refuse to allow CPS to release Directory Information. Please indicate if you wish to restrict IIGP from releasing Directory Information on the student named below by checking the appropriate box and returning this form to your child's school.

Authorization

Name of Parent

Name of Parent/ Guardian or Student 18 years old

authorize the release of records pertaining to

Student's Name

Student's Birthdate

From the following school or institution:

Most Recent School

Address of School or Institution

Telephone No.

Fax No.

Grade Level

The following records* should be released:

Transcript of subjects and grades
Attendance Record
Psychological or Other Individual Test Results
504 Accommodation Plan
English Language Proficiency Assessments
Special Education Records, including IEP, MFE or ETR, and behavior plan
MS Achievement and Graduation Test Results
Standardized Test Results
Gifted Assessments
Health Records

* Records that cannot be withheld due to non-payment of fees or obligations: State test scores, Individualized Educational Program (IEP), IEP progress reports, Multifactored Evaluation (MFE) or Education Team Report (ETR), and immunization records.

Release records to:

New School

Address of New School

Telephone No. (New School)

Fax No. (New School)

I am authorizing the release of these records because (Check one):

I am the parent, guardian or custodian of the subject of these records, and the subject is under 18 years.

I am the subject of these records, and I'm 18 years of age or older.

Signature

Maximum upload size: 5MB

Supported file type: jpg, jpeg, jpe, png, gif

Date of signature