Dr. Robin Ballard
Dr. Peggy J. Rogers
Assistant Superintendent
Assistant Superintendent
Lowndes County School District
Percy Lee
Dr. Susan Johnson
1053 Hwy 45 South – Columbus, MS 39701
(662) 244-5000 – Fax (662) 244-5043
Vocational and Tech Prep Director
Special Education Director
Lotis Johnson
Betty Clinton
Business Officer/Administrator
Child Nutrition Director
Lynn Wright
Superintendent
Veronica Hill
“Challenge
all students to attain their greatest potential.”
Personnel Director
Sam Allison
Principal
Jeanise Andrews
Technology Coordinator
New Hope Middle School
462 Center Road
Columbus, MS 39702
(662) 244-4740
(662) 244-4758 fax
Shelle Bates
Counselor
Name and Address of last school attended:
Student’s Name:
D.O.B.
Grade:
Signature of Parent/Guardian:
Date:
The above named student has applied for enrollment in this school. We request the transfer of all
cumulative records pertaining to the above named student. Please include up-to-date grades,
six/nine weeks’ grades, semester grades, test data, and health records.
Please send all special education records if they apply to the above named student.
Disclosure: It is not necessary for parents to sign a release when records are being passed from
public school to public school. Note: Federal Register, June 17, 1976. Part II, H., E., W., Privacy
Rights of Parents and Students. Final rule on education records, Vol. 41, #118-24673.
School Official’s Signature:
Date Requested: __________
Please forward records to:
New Hope Middle School
Attn: Tonya Hardin
tonya.hardin@lowndes.k12.ms.us
462 Center Road
Columbus, MS 39702
2015-2016
NEW HOPE MIDDLE SCHOOL
NEW STUDENT CHECKLIST
All students at New Hope Middle School must have the following:
_______________________
Immunization Sheet
__________________________
Social Security Card
__________________________
Certified Birth Certificate
__________________________
Two current proofs of residency
___________________________
Grades/report card from previous school
2015-2016
LOWNDES COUNTY SCHOOL DISTRICT
NEW HOPE MIDDLE SCHOOL REGISTRATION RESIDENCY FORM
STUDENT’S NAME: ___________________________________________________________
PARENT/LEGAL GUARDIAN’S NAME: __________________________________________
OTHER ADULTS LIVING IN HOUSEHOLD _______________________________________
ADDRESS ___________________________________________________________________
(PHYSICAL ADDRESS ONLY. PLEASE, NO PO BOX.)
TELEPHONE NUMBER: HOME _____________________ CELL______________________
__________________________________________________________________
__ Student is living with a LEGAL GUARDIAN and a certified copy of the Court Decree, or petition if pending, was received declaring Legal
Guardianship of the above named person who is a resident of the New Hope School District and with whom the student is residing, and
further declaring the guardianship was formed for a purpose other than establishing residency for the school district attendance purposes.
OFFICE USE ONLY
Documents provided to the office by Parent/Guardian
(Minimum of 2 required of ALL enrolling students.)
______ a. Filed homestead exemption application form
______ b. Mortgage documents or property deed
______ c. Apartment or home lease
______ d. Utility bills (current within two months)
______ e. Driver’s license
______ f. Voter precinct identification
______ g. Automobile registration
______ h. Notarized affidavit and/or personal visit by a designated school district official.
Affidavits are to be updated quarterly throughout the year. Failure to provide an
updated affidavit will result in the student being withdrawn from the school.
______ i. Any other documentation that will objectively and unequivocally establish that the
parent or guardian resides within the school district
Date: _______________________ Verified By: ___________
“CHALLENGING ALL STUDENTS TO ATTAIN THEIR GREATEST POTENTIAL”
NEW HOPE MIDDLE SCHOOL
EMERGENCY STUDENT INFORMATION FORM
HOMEROOM: ____________________________
Dear Parent/Guardian,
From time to time emergencies arise, and office personnel must locate a parent of a child, or another child, or
another adult, that can care for the child. This information is important if your child should be injured, become ill, or
if the school must be closed earlier than normal due to an emergency or weather. Please note, students will NOT be
allowed to leave campus with anyone other than those listed below without written consent from a
parent/guardian.
Last Name: ______________________ First Name:________________________ Middle:______
Grade: _________Sex: ____________Race:__________ Birthdate: _______________________
Address: ______________________________________________________________________
Father/Guardian: _______________________________________________________________
Address: ________________________________________________________________
Employer: ______________________________________ Work# __________________
Home# ___________________________ Cell Phone# ____________________________
Mother/Guardian: ______________________________________________________________
Address: _______________________________________________________________
Employer: _________________________________ Work# ______________________
Home# __________________________ Cell Phone# ____________________________
Please list below any adult that may be contacted to pick-up student if needed.
1. Name_____________________________ Relationship _____________________________
Address_________________________________ Phone# ___________________________
2. Name _____________________________ Relationship _____________________________
Address _________________________________ Phone# ___________________________
3. Name _____________________________ Relationship _____________________________
Address _________________________________ Phone# ___________________________
Does your child have any serious allergies or other medical problems of which the office personnel should be aware? Yes _____ No _____
List: ___________________________________________
If your child is seriously injured, and school personnel are unable to contact any person on this form, may the school call an ambulance to
transport your child to an emergency room? Yes _______ No _______
If school is closed earlier than normal because of weather or emergency, may your child walk or ride the bus as usual? Yes _____ No _____
Parent Signature ____________________________________
Date __________________________
Name: _________________
Grade: 6th
NHMS ELECTIVE CHOICE SHEET
Band
Dance
Intro to Show Choir
P.E.
MERIT- For those students who are in the gifted program, MERIT will be scheduled in
the place of ART/CAI Lab
Dance
Please list your choice for Elective on the lines below. We will try our best to
accommodate your first choice. If P.E. or band is your first choice there will be no
need for a second choice.
1st Choice: _______________________
2nd Choice: _______________________