Student Information

First Namerequired

Middle Namerequired

Last Namerequired

Date of Birthrequired

Gender*

Male Female

School Information

Schoolrequired

Applying for School Yearrequired

Graderequired

Date of first enrollment in a Minnesota school district (mm/dd/yyyy)

Has the student attended school outside of the Hopkins School District?*

Yes No

Important Immersion Program Information*

You have selected an Immersion option. Placement into this program requires a completed and approved Chinese or Spanish Immersion Application form before you can complete this Enrollment Form. Have you submitted an Immersion application form?

Yes No

Immersion Application Form Information

Your response indicates you have not completed a Chinese or Spanish Immersion Application form. Please copy and paste this link into your browser to find the application forms for Chinese and Spanish Immersion: https://www.hopkinsschools.org/about/enroll/immersion. Or email Enrollment@HopkinsSchools.org to request a link. Please specify which program (Chinese or Spanish immersion). Thank you.

Important VirtualEDU Enrollment Information*

You have chosen VirtualEDU as your school choice. Placement into VirtualEDU requires a completed and approved VirtualEDU Application Form before you can complete this Enrollment form. Have you submitted a VirtualEDU Application Form?

Yes No

VirtualEDU Application Form Information

Your response indicates that you have not completed a VirtualEDU Application form. Please visit HopkinsSchools.org/virtual and select Enroll from the navigation menu. Or, email Enrollment@HopkinsSchools.org for a link.

Country of Birthrequired

If born outside of the United States, please answer the following three questions.

Date of Entry to United States (mm/dd/yyyy)

Date of first enrollment in USA School (mm/dd/yyyy)

Has the student completed three or more years of school in the US?

Yes No

Previous School Information

Previous School Attendedrequired

Previous School Districtrequired

Date Last Attended (mm/dd/yyyy)

Previous School Address

Address 1

Address 2

City

State

Zip (ex. 06108 or 06108-0809)

Phone

Fax

If you are seeing this text, you answered that your student has not attended school outside of the Hopkins Public Schools District on Page 2 of the Enrollment Form.

If this is correct, please select the "Next" button.
If this is incorrect, please select the "Back" button and revise your response to "Yes" on the "Has your student attended school outside of the Hopkins School District?" question.

Educational Services

Has documentation of this student’s current immunization records been submitted to the Hopkins School District?*

Yes No

Have you moved to Hopkins School District within the last 36 months for temporary or seasonal agricultural or fishing work?*

Yes No

Are the student's parents or legal guardians on active duty or training with the Army, Navy, Air Force, Marine Corps, or Coast Guard?*

Yes No

Does your child receive any services in the following areas? Check those that apply:*

Please answer the questions below to best describe your living situation. The purpose of this information is to ensure the rights of you and your children under the McKinney-Vento Act. The information you provide is confidential.

Is the student's current address a temporary (short term) living arrangement?*

Yes No

If yes, please answer the following:

Student is living in a shelter or transitional living program Student is living doubled up with a relative or friend (parent is not on lease) Student is living on streets, car or in other unsafe conditions Student is living in a hotel/motel Student is under 18 and is not living with a parent or guardian

Upload Birth Certificate

Max file size: 10 MB

Ethnic and Racial Demographic Designation

Schools are required to report ethnicity and race to the state and to the U.S. Department of Education. Because of recent changes to Minnesota state law, Minnesota disaggregates each category into detailed groups to further represent our student populations. Parents or guardians are not required to answer the federal questions for their children. If you choose not to answer the federal questions, federal law requires schools to choose for you. This is a last resort—we prefer if parents or guardians complete the form. State questions are labeled as “Optional” and schools will not fill in this information for you.

This information helps improve teaching and learning for everyone and helps us accurately identify and advocate for students currently underserved. The information this form collects is considered private information. You can review the privacy notice to learn more about the purpose of collecting this information, how it will be used and not used, and how the detailed groups were identified.

Is the student Hispanic/Latino as defined by the federal government?

The federal definition includes persons of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Yes No

Does the student identify as American Indian or Alaska Native as defined by the state of Minnesota?

The state of Minnesota definition includes persons having origins in any of the original peoples of North America who maintain cultural identification through tribal affiliation or community recognition. [This question is needed to calculate state aid/funding.]

Yes No

Select all that apply from the list below (this question will not be answered by school staff):

Is the student American Indian from South or Central America?

Yes No

Is the student Asian as defined by the federal government?

The federal definition includes persons having origins in any of the original peoples of the FarEast, Southeast Asia, orthe Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Yes No

Is the student Black or African American as defined by the federal government?

The federal definition includes persons having origins in any of the black racial groups of Africa.

Yes No

Is the student Native Hawaiian or Other Pacific Islander as defined by the federal government?

Yes No

Is the student white as defined by the federal government?

Yes No

Household Information

Proof of Residency

Upload Options: Utility bill delivered within last 30 days; (water, electrical, or gas bill. Original copy of current fully executed (signed) lease/rental agreement or purchase agreement for home.

Max file size: 10 MB

Primary Household

Street Address Line 1required

Street Address Line 2

Cityrequired

Staterequired

Ziprequired (ex. 06108 or 06108-0809)

Primary Household Phone

Primary Household Adult 1

Firstrequired

Lastrequired

Gender*

Male Female

Relationship to Studentrequired

Cell Phone

Work Phone

Ext

Email

Primary Household Adult 2

First

Last

Gender

Male Female

Relationship to Student

Cell Phone

Work Phone

Ext

Email

Other Children in Primary Household

First

Last

Gender

Male Female

Relationship to Student

Birth Date (mm/dd/yyyy)

First

Last

Gender

Male Female

Relationship to Student

Birth Date (mm/dd/yyyy)

First

Last

Gender

Male Female

Relationship to Student

Birth Date (mm/dd/yyyy)

First

Last

Gender

Male Female

Relationship to Student

Birth Date (mm/dd/yyyy)

First

Last

Gender

*Other?

Male Female

Relationship to Student

Birth Date (mm/dd/yyyy)

Secondary Household

Street Address Line 1

Street Address Line 2

City

State

Zip (ex. 06108 or 06108-0809)

Home Phone

Secondary Household Adult 1

First

Last

Gender

Male Female

Relationship to Student

Cell Phone

Work Phone

Ext

Email

Secondary Household Adult 2

First

Last

Gender

Male Female

Relationship to Student

Cell Phone

Work Phone

Ext

Email

Other Children in Secondary Household

First

Last

Gender

Male Female

Relationship to Student

Birth Date (mm/dd/yyyy)

First

Last

Gender

Male Female

Relationship to Student

Birth Date (mm/dd/yyyy)

First

Last

Gender

Male Female

Relationship to Student

Birth Date (mm/dd/yyyy)

First

Last

Gender

Male Female

Relationship to Student

Birth Date (mm/dd/yyyy)

Health Information

The following information is helpful in establishing a comprehensive picture of your child’s health and safety needs while at school. The information on this form will be entered into the district’s secure electronic data system and considered confidential. There will be no consequences for not providing the information. However, it may result in an incomplete health and safety plan for your child. The information you provide will be shared only with staff in the school district whose jobs require access to this information to ensure your child’s safety and school success. (MS Section 13.04, Subdivision 2)

Health or Disability Concerns

Please indicate if your child has any of the listed health concerns and explain:

Does your child have any health concerns?

Yes No

Does your child have allergic reactions to be aware of at school?

Yes No

Please list your child's allergies:

Please list your child's allergic reactions:

Does your child take allergy medication?

If your child will require an epi-pen, you will need to complete a consent form, signed by your pediatrician.

Yes No

Does your child have an attention disorder?

Yes No

Please select your child's attention disorder(s):

ADD ADHD

Does your child take attention disorder medication?

Yes No

Does your child have asthma?

Yes No

Please list your child's known asthma triggers:

Does your child take medication for their asthma?

Yes No

Does your child have Autism Spectrum Disorder?

Yes No

Age of diagnosis:

Does your child have diabetes?

Yes No

Please indicate what type of diabetes your child has:

Type 1 Type 2

Please select what medications your child takes for their diabetes:

Insulin Injections Insulin Pump Oral Medications

Does your child have heart problems?

Yes No

Please describe your child's heart problems:

Does your child have hearing loss?

Yes No

What ear(s) are affected?

Left Ear Right Ear

Indicate if your child wears hearing aids.

Left Ear Right Ear

Does your child have vision impairments?

Yes No

Does your child use glasses/contacts?

Wears glasses/contacts Wears glasses/contacts in classroom only Glasses/contacts are lost or broken

Does your child have any neurological conditions?

Yes No

Please list what neurological condition(s) your child has:

Does your child have seizures?

Yes No

What type(s) of seizures does your child have?

Date of last seizure: (mm/dd/yyyy)

Has your child had a recent surgery or hospitalization?

Yes No

Please explain hospital stay:

Does your child have mental health concerns?

Yes No

Please list your child's mental health concerns:

Does your child have any other health concerns or additional health information that you'd like to provide?

Yes No

Please list additional health concerns or information:

Emergencies

Does your child have a health concern that could result in an emergency?

Yes No

Please describe:

Medications

List all medications that your child takes every day or when needed.

* Consent forms are required yearly for ALL medications administered at school. Forms are available on-line or in nurses offices

Medication

Purpose

Dose

How Often Taken

Medication

Purpose

Dose

How Often Taken

Additional Information

Does your child need a special diet?

Yes No

Please describe your child's dietary needs:

Has your child had an Early Childhood screening?

(Pre-School and Kindergarten only)

Yes No

Location of Early Childhood screening:

Date of Early Childhood screening: (mm/dd/yyyy)

Do you have any comments or information that would help us care for your child’s health needs while at school?

Parent/Guardian Signature

Parent/Guardian Signature:

Today's Date (mm/dd/yyyy)

Primary Phone:

Emergency Contact/Authorized to Pick Up Student

Primary Phone:

Emergency Contacts

Please add contact information for at least one emergency contact.

Namerequired

Relationship to Studentrequired

Cell Phonerequired

Other Phone

Name

Relationship to Student

Cell Phone

Other Phone

Name

Relationship to Student

Cell Phone

Other Phone

Languages

Minnesota Language Survey

Minnesota is home to speakers of more than 100 different languages. The ability to speak and understand multiple languages is valued. The information you provide will be used by the school district to see if your student is multilingual. In Minnesota, students who are multilingual may qualify for a Multilingual Seal upon further assessment.

Additionally, the information you provide will determine if your student should take an English proficiency test. Based upon the results of the test, your student may be entitled to English language development instruction. Access to instruction is required by federal and state law. As a parent or guardian, you have the right to decline English Learner instruction at anytime. Every enrolling student must be provided with the Minnesota Language Survey during enrollment. Information requested on this form is important to us to be able to serve your student.Your assistance in completing the Minnesota Language Survey is greatly appreciated.

Student’s Full Name:required

Birthdate or Student IDrequired

Select the phrase that best describes your student:

My student first learned:*

language(s) other than English English and language(s) other than English only English

Indicate the language(s) other than English in space provided:

My student speaks:*

language(s) other than English English and language(s) other than English only English

Indicate the language(s) other than English in space provided:

My student understands:*

language(s) other than English English and language(s) other than English only English

Indicate the language(s) other than English in space provided:

My student has consistent interaction in:*

language(s) other than English English and language(s) other than English only English

Indicate the language(s) other than English in space provided:

Language use alone does not identify your student as an English learner. If a language other than English is indicated, your student will be screened for English language proficiency.

Parent/Guardian Signature:required

Daterequired (mm/dd/yyyy)

*All data on this form is private. It will only be shared with district staff who need the information to best serve your student and for legally required reporting about home language and service eligibility to the Minnesota Department of Education. At the district and at the Minnesota Department of Education, this information will not be shared with other individuals or entities, except if they are authorized by state or federal law to access the information. Compliance with this request for information is voluntary.

Interpreter Needs

Do you need an interpreter?*

Yes No

If yes what language?

Student Digital Equity

These questions collect information on student access to the Internet and electronic devices used for schoolwork in the student’s home.

Hopkins Public Schools may use this information to identify students that could benefit from additional support to make sure they can access learning opportunities outside the classroom or school building. It is important that we gather accurate information from every student so that each student and family has the equipment, help, and support needed.

The information you provide will be reported to the Minnesota Department of Education (MDE). MDE may provide state- or school-level summary data — without personal, identifying information — to the Governor, legislators, agency staff, and external partners who have established data sharing agreements and protocols. Hopkins Public Schools will not share your personal, identifying information with others without your consent.

Does the student use an electronic device like a computer, tablet or smart phone to complete homework?*

Yes No

What type of electronic device does the student usually use to complete homework?*

Is the electronic device (from previous question) provided by the school?*

Yes No

Is the electronic device shared with anyone else in the home?*

Yes No

Can the student access the Internet on their electronic device at home?*

No, Internet is not available at home No, Internet is not affordable at home No, Other Yes

Can the student stream a video on their electronic device without pauses?*

Yes, with no pauses or buffering Yes, with some pauses or buffering No, streaming doesn’t work

Release of Records Authorization

By typing your name below, you approve the release of the following records to Hopkins Public Schools.

Student's Name

Today's Date (mm/dd/yyyy)

Information to release

Academic records (including grades to date when possible)
Educational testing records
Special Education records (including Progress Reports and Evaluations)
ELL/LEP Records (ACCESS, TEAE, SOLOM, MAP Reading, etc)
Psychological testing records
Health records (including immunizations)
Discipline records
GRAD testing records (secondary students)

Please forward the above mentioned records to (select one):

**Please note: The Federal Education Rights and Privacy Act (FERPA) allows schools to disclose student education records, without consent, under the following conditions (34 CFR 99.31):

School officials with legitimate educational interest
Other schools to which a student is transferring

Parent/Guardian Signature

I herby verify that the provided information is true and correct to the best of my knowledge and belief. I understand that completing this form enrolls my student in the Hopkins Public Schools and grants permission to obtain all student records pertaining to my child.

Parent/Guardian Signature

Today's Date (mm/dd/yyyy)