New Student Registration, Residence Certification Form Page 2
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3Has child received special services: ☐ Gifted & Talented
☐ IEP ☐ 504 Plan (Please attach current IEP or 504 plan)
Ethnicity: Is student Hispanic: Y N ☐White ☐Asian ☐Black or African American ☐American Indian/Alaskan
☐ Native Hawaiian/ Pacific Islander
Is a member of the family in the Military: ☐Y ☐N
Student Education/Disciplinary Records From Previous School
School Name: __________________________________________________
Street Address: _____________________________ City: ____________________________ State: _______ Zip Code: _______
Name of Principal: _________________________________ Phone Number: ___________________ Fax Number: ___________
Student's Current Grade Level: _________ Reason for transfer: ____________________________________________________
Name of school that student is transferring from: _________________________________________________________________
Is the student currently subject to expulsion or suspension from the school from which he/she is transferring OR has the student
withdrawn from the school before an expulsion hearing or suspension?
Yes
No
If the answer is yes, please attach a written statement of the circumstances. If the student has been expelled or suspended, or withdrew
from school before an expulsion hearing or suspension, the student will not be allowed to enroll in the __________ schools until the
Superintendent has made a determination as to whether to admit the student and if so, under what conditions.
The applicant is hereby notified that the Cape Elizabeth School Department, in accordance with 20-A M.R.S.A. Section 6001-B, shall
request all of the student’s education and disciplinary records from the school he/she is transferring from. The Cape Elizabeth School
Department may also request an oral or written report from the previous school as to whether the student has been expelled or
suspended, or withdrew from school before an expulsion hearing or suspension.
If an applicant is allowed to enroll in the Cape Elizabeth schools pending receipt of education and disciplinary records, such
enrollment shall be considered conditional until the Superintendent has made a determination as to the student’s disciplinary status in
the previous school.
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