Name of Last School Attended _____________________________________________
School Address _____________________________________________________________
Street Address City State Zip Code
School Phone Number _____________________________________________________
School Fax Number _____________________________________________
Student (s) Name _______________________________ DOB __________Grade ____
_______________________________ DOB __________Grade ___________________________________ DOB __________Grade ____
The above named student(s) have been registered at Hickory Center Elementary. We would appreciate receiving the following information:
_____ EDUCATIONAL RECORDS- Include levels, progress reports, standard tests, scores, educational evaluations, most recent grade card
_____ MEDICAL RECORDS- Include physical and all health and immunization records.
_____ STUDENT SERVICE INFORMATION- Include special education records, as well as all psychological, psychiatric, and planning and placement team recommendations.
_____ RACE/ETHNICITY Reporting Form
_____ HOME LANGUAGE SURVEY (HLS) Form
_____ ENGLISH LANGUAGE LEARNER (ELL) RECORDS- Evaluations, scores, levels,
Please deliver, mail, or fax completed information to the school that your child will be attending.