Enrollment Application

    • Enrollment is between 9:00 a.m. – 2:00 p.m. Monday through Friday. 
    • Upon enrollment, student must be at least 16 years old, no more than 21 years old and have previously been in the 9th grade. 
    • If a student was expelled from a previous school, parent/guardian must bring the expulsion letter. At that time, a determination regarding enrollment will be made by the Director. 


Documents needed to enroll 16 or 17 year olds (must have first 6 items): 

- Parent/Guardian and student must be present at time of enrollment 

- Parent MUST HAVE ID and student MUST HAVE STATE ID 

Court-ordered custody papers, if applicable 

- Birth Certificate 

- Social Security Card 

- Complete shot (immunization) records from birth to present 

- Current month LIGHT or GAS bill ONLY (from address at which the student is living) 


* Official transcripts from last and previous schools attended 

* Withdrawal letter at time of enrollment 


Documents needed to enroll 18 to 21 year olds (must have first 5 items): 

- Student MUST HAVE STATE ID or DRVER’S LICENSE 

Court-ordered custody papers, if applicable 

- Birth Certificate 

- Social Security Card 

- Complete shot (immunization) records from birth to present 

- Current month LIGHT or GAS bill ONLY (from address at which the student is living) 

* Official transcripts from last and previous schools attended 

* MUST HAVE withdrawal letter at time of enrollment 

* MUST HAVE ALL DOCUMENTS and a COMPLETED APPLICATION to be                                           accepted for enrollment. 



Student Information









MM/DD/YYYY






Parent/Guardian Information
The following information should be completed referring to parent(s), guardian(s), and/or grandparent(s) with who the student resides:
















Parent/Student Contract

We have read and understand all of the information contained in the Parent/Student Handbook. By signing below, I/we agree to abide by and support the Marshall High School rules and regulations, including the Code of Conduct and all other policies, as outlined in the Parent/Student Handbook. Although the Parent/Student Handbook reflects the current policies of Marshall High School, it may be necessary to make changes from time to time to best serve the needs of our school and its students.



I hereby state that the information provided in this document is true and current. I am the legal guardian or custodian of this student. 

PARENT/GUARDIAN Email


Student's Family Data
Please check all that apply in the following categories:

Only choose Mother & Stepfather or Father & Stepmother if BOTH the parent and stepparent have legal custody of the student and documentation can be provided.






If different from Parent/Guardian listed above


If different from Parent/Guardian listed above


* Please Note: Responding Yes will NOT exclude the student


(First, Last)

(###) ###-####
Student Ethnicity


(If Multi-racial is selected, please check two (2) or more Race groups below)
Student's Previous Education



If Yes, please provide a copy of the student’s I.E.P. and Evaluation.

List of Previous Schools

(Up to 5 - Middle & High School only)




Suspended/Expelled/Dropped Out




Suspended/Expelled/Dropped Out




Suspended/Expelled/Dropped Out




Suspended/Expelled/Dropped Out




Suspended/Expelled/Dropped Out

Page 2

EMERGENCY MEDICAL AUTHORIZATION










Purpose - To enable parents and guardians to authorize the provision of emergency treatment for their child who 

becomes ill or injured while under the school's authority when parents or guardian cannot be reached. 

Residential Parent or Guardian








Example: the name of an Aunt, Cousin, Grandmother or friend with whom you live.

PART 1 OR PART 2 MUST BE COMPLETED
Part 1 - Grant Permission
I hearby give consent for the following medicalcare providers and local hospital to be called








In the event reasonable attempts to contact me have been unsuccessful I hereby give my consent for (1) the admission of any treatment deemed necessary by above named doctor; or the event the designated preferred practitioner is not available, by another licensed physician or dentist and (2) the transfer of the child to any hospital reasonable accessible. 

This authorization does not cover major surgery sunless the medical options of two other licensed physicians or dentists concur in the necessity for such surgery are obtained prior to the performance of such surgery. 




Part 2 - Refusal to Consent

I do not give my consent for emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, I wish the Marshall High School authorities to take the following action: 



Page 3

HOME LANGUAGE SURVEY







City
State
Country










* * * * * * * * * * * * For Parents/Guardians * * * * * * * * * * * 






If the answer to any of the first four questions above is a language other than English, indicate the student's native/home language in EMIS Student Data Element (G-1270), and proceed to assess the student's 

English Language Proficiency. 

Page 4

Edit section title

Media Release/Student Information Form


TO BE COMPLETED BY PARENT, GUARDIAN or ADULT STUDENT: 









I/we understand that as part of my/our child’s attendance at Marshall High School (“School”), photos, videos, 

and quotations may be taken for use in publications and reports about the program. I/we further understand 

that members of the news media invited to cover the program may take photos, videos and quotations. 

I/we grant permission to the School and its Board of Directors, Management Company, employees, 

agents and representatives to use such materials for the promotion of the program and to use this 

student’s name, photographic likeness, alone or in a group, in any publication, document, TV production, video or to release said name or likeness to any media outlets including, but not limited to, newspapers, magazines or TV stations for publicity and/or recognition purposes and/or to use this student’s name 

and/or photographic likeness, alone or in a group, on the official website of the School and/or 

Management Company. 

I agree that I and/or my child shall have no right, title, or interests in any photo or videotape covered 

by this agreement and waive any right to compensation for such use. I release the School, its Board of Directors, the Management Company, employees, agents, representatives and all organizations and individuals related to the School from any and all liabilities or damages that result from the use of this student’s name and/or photographic likeness as described above. 





Page 5

FERPA Consent

The Family and Educational Rights and Privacy Act (FERPA) provides parents and students over 18 years of age ("eligible students") certain rights regarding the student’s educational records. In order to serve the student's educational needs, Marshall High School may find it necessary to disclose a student's name and address to a vendor to provide them with the appropriate learning solutions. These vendors agree to the confidentiality of the student's name and address and will not use such information for any purpose other than those required under their vendor contract with Marshal High School. I hereby agree that my student's name and address may be provided to these entities to ensure that Marshall High School can best meet the educational needs of my student.  

Confidentiality and Communication Consent

As the parent/guardian, I agree to allow Marshall High School personnel the right to contact me or my student in any manner of communication that pertains to the student's academic well-being. This may include, but is not limited to: Director, Assistant Directors, Teachers, Family Advocate, Employability Specialists, Administrative Assistants, and EMIS/Student Data Specialists. This information will remain confidential except in cases where there is an ethical and or legal responsibility to limit the above said confidentiality. 





Page 6

CAREER BASED INTERVENTION PROGRAM INFORMATION

As a Student at Marshall High School, you will be participating in a Career Based Intervention Program. This Program allows the Student to earn high school credits for time spent at work. In order to receive the appropriate amount of credits for work, the Student must regularly provide the School with employment information including but not limited to the name and address of the employer, the amount of time worked per pay period, the date of termination/last date worked, and efforts made to obtain new or previous employment. Failure to provide appropriate documentation will prevent the Student from earning the corresponding credits. All Students are required to complete all regular academic coursework. Additionally, Students under the age of 18 must have a valid work permit. 

STUDENT AND PARENT CONTRACT FOR CAREER BASED INTERVENTION

The Career Based Intervention (CBI) Program is designed to give students the opportunity to complete their education while learning the obligations of the world of work. The success of students in the CBI Program is dependent upon their desire to improve. There are definite responsibilities the STUDENT must agree to carry out before being enrolled: 


I,
,agree to the following conditions:
Student Name First Last
  1. To be in school every day and on time unless excused from school. 
  2. If in a paid work experience, to be at work on time and to miss work only if excused by the employer, school, or parent. 
  3. If it is necessary to miss a scheduled shift at work, the student agrees to notify the employer in a timely and courteous manner, prior to the time that the student was supposed to begin working his or her shift. 
  4. The Student must notify the School immediately of any school or work problems and accept   the designated   staff member's counseling, guidance, and any reassignments or adjustment of the Student's work experience. 
  5. The Student must exercise good personal hygiene and be properly dressed and groomed per the direction of the School and the Student's employer. 
  6. The Student must understand that s/he may be dropped from the program if s/he cuts a class, lies, cheats, steals, fails a class, or is fired from a paid work experience. 
  7. The Student must report to any work experience in a timely manner and not loiter around the School once dismissed for the day. 
  8. The Student must assume the responsibility of transportation to and from his or her work experience. 
  9. The Student agrees to make an honest effort to succeed in all academic subjects and at work and to perform all academic and work obligations in a manner that will reflect positively on 
  10.  self and Marshall High School. 
  11. The Student agrees to immediately notify the School of any changes in employment, rate of pay job  description, full or part time work status, and residency. 
  12. The Student understands that not fulfilling any of the above conditions may result in dismissal from the CBl  Program and or loss of credits. 

The The Regent High School's Career Based Intervention Program affords the Student the ability to attend school for a shorter time period each day than the required four and one-half hour session. ONLY STUDENTS WHO ARE REGULARLY WORKING MAY TAKE ADVANTAGE OF THIS PRIVILEGE. IF A STUDENT IS NOT REGULARLY WORKING, THE STUDENT MUST ATTEND THE FULL 4.5 HOUR SESSION. 


By signing below the Student acknowledges that s/he will be participating in the Regent High School's Career Based Intervention Program, and that s/he will comply with the rules and regulations of the Program. 



I, the Parent/Guardian fully understand and agree with the goals, program requirements, and rules of the Marshall High School's Career Based Intervention Program. I will fully cooperate with the school to accomplish the goals and to ensure that the requirements are met and the rules are adhered to by my Student. 

I give my permission for my Student, to participate in the Career Based Intervention Program at this school. 



Page 7

Marshall High School

Title I Compact

What is a "school-parent" compact?


Each Title I, Part A School must jointly develop, with the parents of children served under Title I, Part A, a school-parent compact as a component of its written parental involvement policy. A school-parent compact is a written agreement between the school and the parents of children participating in Title I, Part A programs that identifies the activities that the parents, the entire school staff, and the students will undertake to share the responsibility for improved student academic achievement, in addition, the school-parent compact outlines the activities that the parents, school staff, and students will undertake to build and develop a partnership to help the children achieve to the State’s high academic standards. 


What information and opportunities must schools provide parents of children participating in Title I, Part A programs? 


Schools served under Title I, Part A must provide to parents of participating children, in a timely manner, information about the programs, funded by Title I, Part A. That information must include: 

  • A description and explanation of the school’s curriculum; 
  • Information on the forms of academic assessment used to measure student progress; and 
  • Information on the proficiency levels students are expected to meet. 


Upon the request of parents, schools must provide the opportunities for regular meetings for parents to formulate suggestions and to participate, as appropriate, in decisions about the education of their children. The school must respond to any suggestions as soon as practicably possible. The School, the students, and the parents of the minor students participating in activities, services, and programs funded by Title I, Part A of the Elementary and Secondary Education Act (ESEA), agree that this compact outlines how the parents, the entire school staff, and the students will share the responsibility for improved student academic achievement and the means by which the school and parents will build and develop a partnership that will help children achieve the State’s high standards. 


This school-parent compact is in effect during the 2020-2021 school year. 


The purpose of this Compact, found in Section 118 of Public Law 103-382, is to build and foster development of the school-student partnership to help all students achieve the State of Ohio’s high standards. Parent/Guardians, students, and teachers will share the responsibility for improved student achievement. 


Each student is responsible for his or her own academic progress in mastering the necessary skills in order to complete the academic program at Marshall High School. 


The school will provide high-quality curriculum and instruction in a supportive and effective environment that enables all students to meet the State’s student performance standards. 


The school will provide students and parents of minor children with reports on their children’s progress. 


The school will provide parents with opportunities to volunteer, observe, and participate in their child’s learning. The school will provide reasonable access to staff through parent/teacher conferences and consultations 

Student Agreement

Communication between the Student and the School staff is important. As a student who has responsibility for his or her own education, I will attend the daily sessions on a regular basis and do all that is asked of me at the School to the best of my abilities. 

I, the student, agree to Title I service for myself and that I will be responsible for supporting my learning in the following ways: 

  • Attending school regularly and punctually 
  • Being prepared to learn by being well-rested, fed and dressed according to the Marshall High School dress code each day 
  • Being prepared to learn by bringing the necessary supplies and learning tools to class each day 
  • Working on learning activities including computer-based learning, teacher-led, and vocational education to the best of my abilities 
  • Asking questions when I do not know something 
  • Supporting the school in efforts to maintain proper discipline 
  • Respecting all school staff, my fellow students, and the cultural differences of others 


Family Representative Agreement

Communication between the home and the School staff is important. As a parent or adult who has responsibility for the above-named student, I will attend at least one parent/teacher conference during which this Compact will be discussed as it relates to my child’s achievement. I will read each progress report and talk to my child about the progress report. I understand that I will have reasonable access to my child’s teachers, and will be able to observe classroom activities. 


I, the parent or guardian, agree to Title I service for my child and that I will be responsible for supporting learning of my child in the following ways: 

  • Reading Progress Reports 
  • Discussing Progress Reports with my child 
  • Participating in parent/teacher conferences 
  • Monitoring my child’s school attendance 
  • Assisting my child in learning to resolve conflicts in positive ways 
  • Supporting the school in efforts to maintain proper discipline 
  • Respecting all Marshall High School staff and students, and the cultural differences of others 
  • Assuring that my child is prepared to learn by being well-rested, fed and dressed according to the Marshall High School dress code each day and that he/she has the necessary supplies and learning tools to class each day 




Page 8

Family Education Services

Parent/Guardian Consent for Individual and Group Services

Your permission is requested for your child to participate in individual advising sessions and group activities. This time will be used to discuss ideas, behaviors, feelings, attitudes, and opinions of the student. 


Because advising is based on a trusting relationship between the Advocate and the student, the FES Advocate will keep the information shared in the sessions confidential except in certain situations in which there are an ethical and/or legal responsibility to limit confidentiality. In the following circumstances you will be notified. 

  1. If the child reveals information about hurting himself/herself or another person.
  2. If the child reveals information about child abuse.
  3. Other situations that ethically and/or legally compel disclosure. 

By signing this form I give my informed consent for my child to participate in individual advising sessions and group activities. I understand that 

  1. This time will be utilized to strengthen interpersonal skills, discuss feelings, share idea, practice new behaviors, and build self-esteem. 
  2. Anything that is shared during this time will be kept confidential by the Family Advocate except in the above-mentioned cases. 






Page 9


Authorization to release the following records for:





You are authorized to release the following records for:



Specific Data to be Released: 

  • Directory Information 
  • Official Transcripts w/ Seal 
  • Health Records
  • OGT Scores (Scaled & Raw) 
  • Permanent/Cumulative Records
  • Fees / Obligations owed 
  • Pupil Personnel Services/Special Ed
  • Other: IEP / MFE 

Reason for Request: 

  • Enrollment 
  • To aid in present and future educational decisions 

Documents needed to enroll 16 or 17 year olds (must have first 6 items): 

- Parent/Guardian and student must be present at time of enrollment 

- Parent MUST HAVE ID and student MUST HAVE STATE ID Court-ordered custody papers, if applicable 


- Birth Certificate 

- Social Security Card 

- Complete shot (immunization) records from birth to present 

- Current month LIGHT or GAS bill ONLY (from address at which the student is living) 


* Official transcripts from last and previous schools attended 

* Withdrawal letter at time of enrollment 






OHIO REVISED CODE OHIO STATUS 3319.32.1 

Text of Statute: Nothing shall prevent the transfer of a student's record (this includes transcripts and IEP's) to an educational institution for a legitimate educational purpose. A parent, legal guardian or a person 18 years or older can request transcripts upon withdrawal from one public school district for the purpose of attending another school. This is a State Law and must be followed. 

Edit section title
Upload a copy of student's Birth Certificate, Social Security Card and Proof of Residency (Current month LIGHT or GAS bill ONLY from address at which the student is living)