Penelope ISD Enrollment

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Each year all students must provide the following:
Utility bill showing current address

New enrollments must send the following to school at time of enrollment:
Copy of social security card
Copy of birth certificate
Copy of immunizations/shot record
Utility bill showing current address

If interested in insurance for your student , see the administration office for an enrollment form.

Email *

General Information and Medical

Student Name *

Date of Birth *

YYYY

Grade (2022-2023) *

Parent/Guardian Name(s) *

Parent/Guardian Phone Number(s) *

Parent/Guardian Address *

Please list names and numbers of people to call in an emergency. (Do not list the parent or guardian we always call them first.) *

Please choose one of the following: *

As a parent or guardian of the above named student I DO authorize Penelope ISD to take my child to a doctor for treatment of accident or sickness as deemed necessary by proper officials of Penelope ISD.

As a parent or guardian of the above named student I DO NOT authorize Penelope ISD to take my child to a doctor for treatment of accident or sickness as deemed necessary by proper officials of Penelope ISD

Please list the doctors that you wish for your child to see should the need arise. (please give 3 options) *

I agree to assume completely all responsibility for bills incurred for medical expenses. If student insurance is carried I agree to be responsible for all medical expenses in excess of insurance coverage. *

Yes

Texas Public School Student/Staff Ethnicity and Race Data Questionnaire

The United States Department of Education (USDE) requires all state and local education institutions to
collect data on ethnicity and race for students and staff. This information is used for state and federal
accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal
Employment Opportunity Commission (EEOC).
School district staff and parents or guardians of students enrolling in school are requested to provide this
information. If you decline to provide this information, please be aware that the USDE requires school
districts to use observer identification as a last resort for collecting the data for federal reporting.
Please answer both parts of the following questions on the student’s or staff member’s ethnicity and race.
United States Federal Register (71 FR 44866)

Part 1. Ethnicity: Is the person Hispanic/Latino? (Choose only one)

Hispanic/Latino – A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Not Hispanic/Latino

Clear selection

Part 2. Race: What is the person’s race? (Choose one or more)

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 a tribal affiliation or community attachment.

Asian – A person 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.

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, the Middle East, or North Africa.

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