Lanier Middle School Enrollment Packet
PLEASE READ BEFORE YOU START
This packet consist of Registration Enrollment Information for Lanier M.S. Registration Department.
Supporting Documentation
Supporting Documentation and copies that you must bring with you when you register your child are the following:
Proof of Residence (2 copies one for each department- be sure to have student’s name on them)
Types of Proof of Residence ACCEPTED:
Gas, Light, Water Bill must be from the past 30 days to present date counting from the day you are registering your
child.
Lease/Mortgage Agreement must have the parent’s name and student’s name on the lease as tenants, as well as must
be active for the 2016-2017 School Year.
-------------------Parent Identification with Photo (2 copies one for each department)
Types of Parent Identification ACCEPTED:
Driver’s License must be valid and have the address matching Proof of Residence Address.
Passport must be valid.
-------------------Report Card bring us the Final Report Card for the 2014-2015 School Year, and a 2015-2016 Current Report Card. A
Final Report Card for 2015-2016 is Due by: July 16, 2016.
--------------------Shot Records must be up to date, according to child’s age.
Birth Certificate must have original and copy present.
Social Security Card- ONLY IF THIS IS THE FIRST TIME YOUR CHILD ATTENDS A SCHOOL IN HISD.
IMPORTANT NOTE:
The ENROLLMENT PROCESS can ONLY be completed if ALL documentation is incompliance and valid.
QUESTIONS? CONTACT LANIER’S REGISTAR SHELLEY BOBB at 713-942-1900 Ext. 330
REGISTRATION Dates and Times
04/11-22/2016 from 9-11AM and 1-3PM
Houston Independent School District
Enrollment Information
16 - 20____
17
20____
Homeroom Teacher:
¨ Yes
Has student ever attended an HISD School?
HISD Student ID
Federal
Student Ethnicity
(Select One)
Student
Address
Date of Birth
First Name
¨ Hispanic/Latino
¨ Not Hispanic/Latino
Middle Name
Student Race
(Select all that apply)
Street Name
Gender
Student SS# / State Alt. #
(Jr., III, etc.)
¨ Mother
¨ Other
Student Lives with
¨ American Indian or Alaska Native
¨ Native Hawaiian/Other Pacific Islander
Apartment
City
¨ Asian
¨ White
State
Student Cell Phone
Grade
¨ Male
¨ Female
Generation
Year Started School in US
City, State, Country
Street Number
Last School/Daycare Attended
Date of Enrollment
Legal Student Last Name
Student Birthplace:
¨ No
Zip
County
¨ Father
¨ Both Parents
¨ Black or African American
Home Phone
Student e-mail Address
Texas Education Code §25.002(f) requires the school district to record the name, address, and birth date of the person enrolling a child.
Contact #1 Name (Last, First)
Employer
Relationship
Occupation
¨ English
¨ Spanish
Preferred
Language
Employer
Relationship
¨ English
¨ Spanish
Contact #3 Name (Last, First)
Employer
¨ English
¨ Spanish
¨ CHIP
Street Name
Relationship
Street Number
Street Name
Translator Needed?
¨ Yes
¨ No
¨ Vietnamese
¨ Other
What type of medical insurance do you carry for this child?
¨ HCHD
¨ Private Insurance
¨ Medicaid
¨ None
List the names of all brothers and sisters under 18 years of age.
Last, First, and Middle Names
Gender
Birthdate
Grade
Zip
e-mail Address
Apartment City
State
Zip
Cell Phone
e-mail Address
Apartment City
Work Phone
Home Phone
State
Cell Phone
Work Phone
Translator Needed?
¨ Yes
¨ No
Occupation
Preferred
Language
Street Number
Home Phone
¨ Vietnamese
¨ Other
Apartment City
Work Phone
Translator Needed?
¨ Yes
¨ No
Occupation
Preferred
Language
Street Name
Home Phone
¨ Vietnamese
¨ Other
Contact #2 Name (Last, First)
Street Number
State
Zip
Cell Phone
e-mail Address
Family Physician
Physician Phone
(If additional room is needed, write on reverse side.)
Address of This Child
Signature below certifies that all the information above is true and accurate.
Enrollment of the child under false documents subjects the person to liability for tuition or costs under Texas Education Code §25.001(h).
Signature of Contact 1/Legal Guardian
TX Driver's License Number
Date of Birth (Contact 1/Legal Guardian)
Signature of Contact 2/Legal Guardian
TX Driver's License Number
Date of Birth (Contact 2/Legal Guardian)
Total Monthly Family Income:
v 4.3 - JK 07-24-2014
Total Number In Household:
Lanier Middle School
EMERGENCY/RAINY DAY CONTACT INFORMATION
Please list below the individuals who are given permission to pick up your child at
any time during the day.
Student’s Name:
___________________________________________
Name of Person
Phone Number
Relationship
to Student
PLEASE NOTE: ANY INDIVIDUAL PICKING UP A CHILD DURING THE DAY
MUST BE 18 YEARS OF AGE OR OLDER AND MUST PROVIDE PROPER
PICTURE IDENTIFICATION WHEN SIGNING THE CHILD OUT IN THE OFFICE.
_____________________________
Parent Signature
__________________
Date
LANIER MIDDLE SCHOOL
2016-2017
ATTENDANCE GUIDELINES
Please notify the attendance office by 9:00 a.m., at 713-942-1925, if your child is going
to be absent from school. Always send a note with your child when he/she returns to
school in order that the absence may be considered excused. If the attendance office
does not receive a note signed by the parent within three days after the date of the
absence, the absence will be considered unexcused.
The Texas Education Code states:
1. It is the parent’s duty to monitor the student’s attendance, require the student to
attend school, and the parent is subject to prosecution under Section 25.093 for
failure to require the child to attend.
2. If a student is absent from school three days or parts of days in a fourweek period without parental consent or is absent without an excuse for more than
ten days or parts of days in a six-month period:
a. the student’s parents or legal guardian is subject to prosecution under
TEC 25.093
b. the student is subject to prosecution under TEC 25.094
3. Section 25.0951 requires the district to:
a. file a complaint against the student or the student’s parent or
both in a justice or municipal court if the student fails to
attend school without an excuse on ten or more days or parts
days within a six-month period in the same school year; or
b. refer the student to a juvenile court for conduct indicating a
need for supervision under Section 51.03 Family Code
4. TEC 25.092 states that a student may not be given credit for a class
unless the student is in attendance for at least ninety percent of the
days the class is offered.
5. Middle school students in year long courses, which meet every other
day, may have no more than four unexcused absences to be
considered for promotion.
I have read and understand the Above Attendance Guidelines.
___________________________
Student’s Name
__________________________
Parent’s Signature
HOME LANGUAGE SURVEY
HOUSTON INDEPENDENT SCHOOL DISTRICT
Student Name: _________________________________ School: ______________________________________
Student Address: ________________________________ Home Phone: _________________________________
Date of Birth: ___________ ______ ________ Grade: __________ HISD ID#: __________ PEIMS#: __________
Month
Day
Year
The Texas Education Code requires schools to determine the language(s) spoken at home by each student.
This information is essential in order for schools to provide meaningful instruction to all students. Please answer
the following questions.
PART A:
(I) Place of Birth (Country of Origin)
(I) Date of initial entry into U.S.
(I) Number of complete academic
schools
years in a U.S. school _________
City ____________ Country ________ Month_____ Day ____ Year______
(I) When your child lived outside the U.S., did he or she attend school regularly? (□ Part Time or □ Full Time)
 Yes, my child attended school regularly in all previous grades outside the U.S.
 No, my child missed significant portions of one or more school years, as specified:
Specify grade and time period, including month and year (example: Grade 2, Jan. 2002 through May
2002). Do not include periods of absence that lasted less than one month. Do not include regularly
scheduled school holidays or vacations.
____________________________________________________________________________________
PART B:
1. What language is spoken in your home most of the time?
□ English
Other (Specify) ___________________________________
2. What language does the student speak most of the time?
□ English
Other (Specify) ___________________________________
Grades PK – 8
Grades 9 – 12
__________________________________
(Parent or Guardian)
__________________________________
(Parent or Guardian or Student)
__________________________________
(Date)
__________________________________
(Date)
NOTE TO SCHOOL PERSONNEL:
1. The original signed copy of the Home Language Survey (HLS) must be
filed and kept in the student’s permanent folder.
2. In Part A, items marked with an (I) are required for identification of
immigrant students. (Refer to Bilingual/ESL Program Guidelines for
identification procedures). An immigrant student is one who was born
outside of the United States or its territories and has been attending
schools in the United States for less than three complete academic
years.
3. In Part B, an answer of a language other than English to either question
#1 or #2 identifies a student for oral language proficiency assessment
(and written testing if entering Gr. 2-12).


Yes, NEEDS OLPT ENTRY TESTING
(If entering grades PK-12)
Yes, NEEDS ENGLISH NRT ENTRY TESTING
(If entering grades 2-12)
Student must be tested, identified,
and placed in an appropriate
program within 4 weeks of
enrollment.
Revised August 2014
Lanier Middle School Information Survey 2016- 2017
Student Name:____________________________ Entering Grade:____
Please answer the following questions by selecting yes or no
Any items with an (*) you will have to provide documentation
Has your child ever attended an HISD school?
If yes, where?__________________________________
Yes
No
Is your child fluent in another language other than English?
If yes, which language?__________________
Yes
No
Has your child ever received Bilingual or ESL services?
If yes, where? ________________________________
Yes
No
Does your child receive Special Education*services?
If yes, please select which service:
⃝ Resource ⃝ Speech ⃝ Other (Please specify below)
__________________________________________________
__________________________________________________
__________________________________________________
Date of Promotional ARD (most recent) ________
“Please provide a copy of all documentation”
Yes*
No
Has your child received Section 504* services in the past?
If yes, where? ________________________________ School
“Please provide a copy of all documentation”
Yes*
No
Has your child been identified as Gifted and Talented*?
If yes, where? ________________________________ School
“Please provide a copy of all documentation”
Yes*
No
Has your child ever been retained?
If yes, which grade?_______
Yes
No
Did your child attend Summer School * for the 2015-2016
School Year?
“Please provide a copy of all documentation”
Yes*
No
Is there any medical concerns we should know of? If yes, explain _____________________
___________________________________________________________________________
___________________________________________________________________________
Parent Signature:___________________________ Date: ___________
2016-2017 HOUSTON INDEPENDENT SCHOOL DISTRICT
STUDENT ASSISTANCE QUESTIONNAIRE (SAQ)
All information MUST be completed by parent, school personnel or community liaison.
School ___________________________________________________________________
Date______________________
Student Name ___________________________________________________ Date of Birth_______________ HISD ID _____________
Current Address _____________________________________________________________ Grade ________
 Male
 Female
Lives with:  Both Parents,  Mother,  Father,  Legal Guardian,  Caretaker/Relative without legal guardianship,  Other _____________
relation
Is the student currently in the conservatorship of the Department of Family & Protective Services (Foster Care)?
 Yes
 No
If Yes – name of DFPS Case Manager: ___________________________________ Contact information: __________________________________
Was the student previously in the conservatorship of the Department of Family & Protective Services (Foster Care)?
 Yes
 No
Please complete the Current Housing Situation AND Background Situation sections below to determine Mckinney-Vento eligibility:
Part A: CURRENT HOUSING SITUATION – Check the student’s current housing situation
I CURRENTLY LIVE:
 In my own home or apartment, in Section 8 housing, HUD Subsidized Housing or in military housing with parent(s), legal guardian(s), or
caregiver(s) (if you checked this box, check one or both of the boxes below, if applicable.
 My home has no electricity
 My home has no running water
OR I CURRENTLY LIVE IN A TRANSITIONAL HOUSING SITUATION:
 Living in a shelter
 Living in a motel or hotel
 Living with more than one family in a house or apartment (Doubled-up) due to economic hardship
Unsheltered
 Moving from place to place
 Living in a structure not usually used for housing 
Living in a car, park, campsite, camper, or outside
UNACCOMPANIED YOUTH  Yes
 No (An unaccompanied youth is a student who is not in the physical custody of a parent or
legal guardian. This would include students living with non-custodial relatives or friends without a parent or legal guardian.)
Part B: BACKGROUND SITUATION (If a Transitional Housing Situation is checked above - please Check ANY below that apply)

Catastrophic illness / medical expenses / disability

Natural disaster / evacuation

New to Town

Domestic Issue

Loss of Employment

Migrant work in fishing or agriculture

Economic hardship/low earnings

Awaiting placement in foster care / CPS custody

Evicted/kicked out

Parent(s) involved in military deployment

House fire or other destruction

Parent Incarcerated/Recently released from incarceration
Part C: NEEDED SERVICES – based on availability (Check services needed and call 713-556-7237 to speak to an Outreach Worker)

Enrollment Assistance
 Transportation
 Emergency Clothing, Uniforms

Free Lunch/Breakfast (Child Nutrition)
 School Supplies
 Personal Hygiene Items

Immunizations
 Medicaid/CHIP Assistance
 Food Stamps (SNAP) Assistance

Temporary Assistance for Needy Families (TANF)
 Other ___________________________
To the best of my knowledge this information is true and correct.
Name (PLEASE PRINT): _____________________________________ Signature ____________________________ Phone #’s _________________________
School Personnel: This form is intended to address the McKinney-Vento Act U.S.C. 11435. If any “Transitional Housing Situation” is checked
under “Current Housing Situation” AND the family has indicated one of the “Background Situations” (1) immediately add PEIMS Coding on the Atrisk Chancery panel for At-risk reason code 12, (2) code all of the McKinney-Vento Panels on that screen (the start date should be the date the form
was completed and also add the end date, and (3) fax this form immediately to 713-556-7024.. If information is missing, please follow-up with the
parent/guardian/school personnel who completed the form to make sure each section is completed, as needed.
Student Media Consent and Release Form
Throughout the school year, students may be highlighted in efforts to promote HISD activities
and achievements. For example, students may be featured in materials to train teachers and/or
increase public awareness of our schools through newspapers, radio, TV, the web, DVDs,
displays, brochures, and other types of media.
I, as the parent or guardian of ________________, hereby give HISD and its
employees, representatives, and authorized media organizations permission to print,
photograph, and record my child for use in audio, video, film, or any other electronic,
digital and printed media.
a. This is with the understanding that neither HISD nor its representatives will
reproduce said photograph, interview, or likeness for any commercial value or
receive monetary gain for use of any reproduction/broadcast of said photograph
or likeness. I am also fully aware that I will not receive monetary compensation
for my child’s participation.
b. I further release and relieve HISD, its Board of Trustees, employees, and other
representatives from any liabilities, known or unknown, arising out of the use of
this material.
I certify that I have read the Media Consent and Release Liability statement and fully
understand its terms and conditions.
Please understand that failure to return this release form within ten (10) school
days from the date of distribution will constitute approval of the above requests.
Please Print
Name of child __________________________________________ Grade___________
Address _______________________________________________________________
City, State, Zip__________________________________________________________
Signature of parent or guardian ____________________________________________
Date____________________ Phone Number ________________________________
STUDENT RECORD REQUEST
PLEASE FORWARD RECORDS FOR THE FOLLOWING STUDENT:
HISD STUDENT ID# : _________________
STUDENT’S COMPLETE NAME: _________________________________________
DATE OF BIRTH: ___________________ CURRENT GRADE: __________
Name of Last School Attended: _________________________________________
School Address: ______________________________________________________
City, State, Zip: ______________________________________________________
PLEASE INCLUDE ALL OF THE FOLLOWING:
WITHDRAWAL FORMS
TRANSCRIPT OF GRADES
PERMANANT RECORD CARD
KEY TO GRADING SYSTEM
TEST RECORDS
REPORT CARD
IMMUNIZATION RECORDS
PARENT SIGNATURE REQUIRED: ____________________________________
Please send the above information at your earliest convenience to:
LANIER MIDDLE SCHOOL
2600 Woodhead / Houston, Texas 77098
713-807-5103 FAX
ATTN: ALMA FLORES
(HISD ROUTE# 6)
40.0150
ADMISSION BLANK
DATE:
___________________
Fill out admission blank in triplicate.
Original to school office • Copy to receiving teacher • Copy to school nurse
NAME: _________________________________________________________________________
Last
First
Middle
I.D. No.: ___________________
GRADE: _________
ADDRESS: ___________________________________________________ ZIP: __________________ TELEPHONE: _____________________________
PARENT’S NAME: ____________________________________________________________________
PARENT’S PHONE: _______________________
LAST SCHOOL ATTENDED: _________________________________________
CODE OF ENTRY: _________
BIRTHDATE: ______________________________________________________
AGE: ___________
ETHNICITY: _______________
PLACE OF BIRTH: __________________________________________________________________________
PEIMS # (if known): ___________________________________
NO. DAYS ATTENDED: ____________
BIRTH CERTIFICATE:
1st
2nd
YES
First
Booster
Date
(month, day, and year)
VACCINES
SEX: ________
NO
Last
Booster
3rd
DIPHTHERIA*
TETANUS
(DPT or DT)
The following information is not required for admission
(voluntary).
POLIO*
MEASLES (rubeola)*
RUBELLA (3-day or May
German measles)
be
MUMPS
combined
(MMR)
SS# ____________________________________________
I 94 ____________________________________________
HIB
Date of entry into USA _____________________________
HEPATITIS B
VARICELLA (chicken pox)
Number of years in USA ____________________________
Number of years in public/private schools ______________
TB SKIN TEST RESULTS
DATE
RESULTS
Date of chicken pox illness
DATE
PHYSICIAN OR CLINIC EXAM
RESULTS
*If the required doses have been received, but the last dose was before the time stated, an additional dose of polio, measles, diphtheria/tetanus is required.
HAVE YOU ATTENDED HOUSTON SCHOOLS BEFORE?
YES
NO
IF ANSWER IS YES: WHEN: __________________________________________ WHERE: _________________________________________________
REPORT CARD: YES
NO
NAME OF TEACHER ASSIGNED: ___________________________________________________________________
Material No. 1069
HISD Graphics: 00-137
AP - 3