Carlton - New Student Form (EC - Grade 12)

Carlton - New Student Form (EC - Grade 12)

Carlton Staff only - Use this to report new students (Early Childhood through Grade 12), returning students or "new to you" students.

Questions marked with an * are required

Case Manager Name *
 
Your email (if you want a copy of the data submitted sent to you via email):
 
Student First and Last Name *
 
State ID/MARSS #
 
Grade * 













 
Birthday
 (mm/dd/yyyy)
 

Residency is determined on where the legal guardian lives regardless of where the student lives.

Enter parent or legal guardian information here.

Parent's Name
 
Parent's Address
 
Parent's City, State, Zip
 
Parent's Primary Phone
 
Relationship to Learner 

 
Have parental rights been terminated? * 

 
Is the student a Ward of the State? * 

 
Attending District* 
 

If the student lives with someone other than the legal guardian, please answer the next set of questions (foster home, grandparent, friend, etc).

Primary Name
 
Primary Relationship 
 N/A 
 
Primary Address
 
Primary City, State, Zip
 
Resident District (resident district is determined by where the legal guardian lives not necessarily where the student lives). *
 
State Aid Category * 



 
Transportation District *
 
Transportation Category * 


 
Attending School * 


 
Adopting Existing IEP * 

 
Enrollment Start Date
 (mm/dd/yyyy)
 
Is this a new IEP/IFSP/IIIP? * 

 
Service Start Date *
 (mm/dd/yyyy)
 
Evaluation Status (SEES) * 
1 - Not evaluated, non-disabled, no IEP/IFSP regular education only2 - Shared-Time K-12 – Evaluated, EC – Evaluated
 3 - Evaluated – requires services but not yet in a program
Evaluated – receiving special education services (IEP/IFSP)
 5 - Evaluated – qualifies for services, parent refused
Evaluated – receiving services in district and receiving services through a public agency (IIIP)
 
Instructional Setting - Ages 6-21 *









 33 - EC or K Program (max 10 hrs/wk in this setting) 





 
Instructional Setting - Ages B-2 * 






 
Instructional Setting - Ages 3-5 *









 
Primary Disability * 













 

Early Childhood Only (B-K)

ECSE Class Placement?
3-5 ECSE Non District
3-5 Non District Speech
3-5 District ECSE
B-3 Home Visits
B-3 Child Care Center
B-3 Home Speech
N/A

 
Evaluation Start Date
 (mm/dd/yyyy)
 
Evaluation End Date
 (mm/dd/yyyy)
 
Total Evaluation Hours
 
Comments
 
 

 

 



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