Hopkinton Public Schools, 89 Hayden Rowe Street Hopkinton, MA. 01748 | (508) 417 9360 | Fax: (508) 497 9833
Registration/Enrollment Packet Checklist
To register a student in Hopkinton Public Schools please complete the forms included
in this packet and contact the school your child will attend to set up an appointment
with a guidance counselor for a consultation and school visit. Guidance counselors
are not available for most of the summer but will be available the week prior to the opening of
school for new student registrations.
School
Hopkinton Pre-School, 88 Hayden Rowe Street
Center School, 11 Ash Street
Elmwood School, 14 Elm Street
Hopkins School, 104 Hayden Rowe Street
Hopkinton Middle School, 88 Hayden Rowe Street
Hopkinton High School, 90 Hayden Rowe Street
Student Services, 88a Hayden Rowe Street
Grade
PreK
K-1
2-3
4-5
6-8
9-12
Telephone
(508) 497 9806
(508) 497-9875
(508) 497 9860
(508) 497 9824
(508) 497 9830
(508) 497 9820
(508) 497 9850
Prior to enrollment of a child in the Hopkinton Public Schools, a parent/guardian must provide a birth
certificate or equivalent proof of age, demonstrate proof of residency, provide legal documentation of
custody (if appropriate) and complete all applicable forms*.
Forms:
 Registration Form
 School Nurse Health and Emergency Information
 Home Language Survey, available in multiple languages
 Bus Transportation Letter and Application Form
 Transportation Arrangement Form, Grades K-5
 Pre-School Information Form, incoming Kindergarten only
 Release of Information Form
 Free and Reduced Lunch Application*
 School Insurance Application*
 Photo Restriction Form*
 CORI Form* (required for all school volunteers)
 Athlete Emergency Information Card, if trying-out for school team*
 MIAA Transfer Rule Form, if athlete has played on a team at another high school*
 MCAS Information Sheet, incoming grades 10-12 only
*These forms are optional
Required Documentation:
 Birth Certificate with a raised seal, or equivalent proof of legal name and age.
 Immunization and Physical Examination Records
o Immunization records with dates of all immunizations as required by MA Dept. of
Public Health
o Proof of a physical exam within one year of starting date, or an appointment for a
physical if the child has not had a physical within the last year

Proof of Residency in the Town of Hopkinton. Refer to School Committee Policies JEB and
JF. Two forms of proof of residency are required. You may choose one from the list below AND a utility bill.
o
o
o
o
Lease Agreement
Notarized Affidavit of Residency
Mortgage Bill (financials and account numbers may be blocked for privacy)
Copy of deed
 Proof of Legal Guardianship may be required
o Current vehicle registration; drivers license
*Please note: Homeless families are not required to provide documentation prior to registration.
***OFFICE USE ONLY***
Date of Entrance:
Proof of Residency Received:
Previous Records Received:
Immunization Record Received:
Birth Certificate Received:
Counselor: ______________________
_____Student ID: _______________Teacher:________________
_____SASID: ___________________Home Room:____________
_____Locker /Advisory:_______________
___________
Date:
Grade Entering:_____
STUDENT INFORMATION (Complete Legal Name):
First: _____________________________ Full Middle Name: ___________________ Last: _________________________________
Nickname: __________________________ Gender: (Circle one) M F
Date of Birth: ________________
City of Birth: __________________________
State: _____
Country: __________________________
Address: _______________________________________ City/Town (Residence): _______________________ Zip: ____________
Mailing Address if Different: ___________________________________________________________________________________
Former School: __________________________________ __________________________ Type:____________________________
Name of School
City/State
Public/Private/Charter
Has student ever attended public school in Massachusetts? ___________ In Hopkinton? _____________
(If different than Former School information)
Ethnicity: (Circle one)
Race: (Circle all that Apply)
Non-Hispanic
Hispanic
American Indian or Alaskan Native, Asian, White, Native Hawaiian or other Pacific Islander,
Black or African American
Parent(s) Status:
( ) Married
( ) Divorced
( ) Separated
( ) Other ________________________________
Child is living with:
( ) Both parents ( ) One Parent: Mom or Dad
( ) Other: _______________________________
Custodial Parents:
( ) Mother
( ) Father
( ) Other: ______________________________________________
Is there any court order in place? ( ) Yes ( ) No
Divorce Decree on file in school: ( ) Yes ( ) No
If parents are divorced, does the non-custodial parent receive information on the child? ( ) Yes ( ) No
If so, what address should it be sent to? (Court order must be in file in the school):
Mother’s/Guardian Information:
Name: _______________________________________ Home Phone #: ___________________Cell Phone #: __________________
Employer: _____________________ Work Phone #: ____________ Email Address:__________________________________(required)
Address if different from above: _________________________________________________________________________________
Father’s/Guardian Information:
Name: _______________________________________ Home Phone #: ___________________Cell Phone #: __________________
Employer: _______________________Work Phone #: _____________ Email Address: _____________________________(required)
Address if different from above: _________________________________________________________________________________
Alert Now Phone Number (Parent #’s to be called in case of emergency dismissals, school closings, etc):
#1: ________________________
#2: ______________________
Person(s) to Notify in Case of Emergency/Illness if Parents cannot be reached:
1. Name: ____________________________________ Home #: _______________________ Cell #: ___________________
Relationship to Student: ________________________ Permitted to pick up student: ______________________
2. Name: ____________________________________ Home #: _______________________ Cell #: ___________________
Relationship to Student: ________________________ Permitted to pick up student: ______________________
Student Educational Information:
Has your child received special education services or accommodations through an Individualized Education Plan (IEP) or Section 504:
( ) Yes ( ) No
Member of Military Family (http://mic3.net/pages/FAQ/faqnew.aspx):
Is the student the child of:
1) An Active duty member of the uniformed services, National Guard and Reserve on active duty orders
2) A member or veteran who has been medically discharged or retired for (1) year
3) A members who died on active duty
( ) Yes
( ) No
SCHOOL NURSES’ STUDENT HEALTH AND EMERGENCY INFORMATION
School _______
Complete the following information and return to school immediately . Contact the School Nurse if you have any questions about this form.
Student’s name ____________________________________________D.O.B____________ Sex__________ Grade__________
Address__________________________________ Home Phone________________ Parent E-Mail Address________________
Mailing Address if different from above____________________________ Student’s Primary Language_________________
Is your child covered by health insurance _____Yes _____No Insurance Company_______________ Policy # __________
If you have no health insurance, Massachusetts has health insurance plans that will provide uninsured children with affordable health care
(resitrictions may apply). Please contact the School Nurse for more information about these prgrams. All Communication will remain
confidential.
Mother/Guardian/Other ______________________________Home Address________________________________________
Work Address_______________________________________ Work Phone _________________ Cell Phone ______________
Father/Guardian/Other _______________________________ Home Address _______________________________________
Work Address _______________________________________ Work Phone _________________ Cell Phone ______________
Emergency Contacts if parents/guardians cannot be reached in emergency. If your child is ill and you are unavailable,
shall the school allow this person to sign your child out of school?
_______________________________________________________________________________ ______Yes ______No
Name
Phone
Dismiss to care of this person?
_______________________________________________________________________________ ______Yes ______No
Name
Phone
Dismiss to care of this person?
_______________________________________________________________________________ ______Yes ______No
Name
Phone
Dismiss to care of this person?
In case of emergency, the school will attempt to contact parent/guardian before calling your child’s primary care provider (physician).
Your child will be transported by ambulance to an emergency are facility if necessary.
_________________________________________________________
__________________________________
Physician’s Name
Physician’s Phone
_________________________________________________________
Dentist’s Name
__________________________________
Dentist’s Phone
Please list all medications that your child takes__________________________________________________________________________
__________________________________________________________________________________________________________________
Please check all that apply to your child:
___ Heart Condition
___ Diabetes
___ Depression
___ Asthma
___ Seizure disorder
___ ADD/ADHD
___ Migraines
___ Other (specify) ___________________________________________________________________________
Known Allergies ______________________________________________________________________________________________________
Any other conditions that the School Nurse should know about? _____________________________________________________________
Does your child
__ wear eyeglasses ?
__ wear contact lenses?
__ wear a hearing aid?
__ Other corrective device?
I give permission to the school nurse to share information relevant to my child’s health condition with appropriate school personnel
when necessary to meet my child’s health and safety needs. I give permission to exchange information with my child’s primary care
physician for the purpose of referral, diagnosis and treatment.
_____________________________________________
Parent/guardian signature
_____________________
Date
I, the undersigned, as parent/guardian of the above named minor child, do hereby permit the hospital and its physicians to perform on
this child any procedures or treatment as may be deemed necessary in an emergency situation.
_____________________________________________
Parent/guardian signature
_____________________
Date
Hopkinton Public Schools Home Language Survey Both state and federal regulations require that all schools determine the language(s) spoken in each student’s home in order to identify their specific language needs. This information is essential in order for schools to provide meaningful instruction for all students. If a language other than English is spoken in the home, the District is required to do further assessment of your child. Please help us to meet this important requirement by answering the following questions. Thank you for your assistance. Student Information _______________________________________________________________________________________ ______________________________ First Name Middle Name Last Name Nickname (if any) F ▢ M ▢ __________________________________ ________/________/__________ Gender Country of Birth Date of Birth (mm/dd/yyyy) School Information ________/________/__________ _____________________ Date first enrolled in ANY U.S. school (mm/dd/yyyy) Current Grade ___________________________________________________________ ______________________________________________ Name of Former School City, State, Country (if outside U.S.) Language Information (to be completed by all parents/guardians) ● What is the native language of each parent/guardian? (circle relationship) _________________________________ (mother / father / guardian) ________________________________ (mother / father / guardian) ● What language did your child first understand and speak? _________________________________________________________________ ● What language(s) does your child know? (circle all choices that apply) ______________________________________ (speak / read / write) ______________________________________ (speak / read / write) Will you require written information from school in your native language? No ▢ Yes ▢ Language: ________________________________ Will you require an interpreter/translator at Parent-Teacher meetings? No ▢ Yes ▢ Language: ________________________________ Languages Other than English (to be completed ONLY if a language other than English is listed above) ● Which language do you use most with your child? Language: _________________________________________________ ● Which language(s) are spoken with your child? (include relatives-‐grandparents, uncles, aunts, etc.-‐and caregivers) Language: __________________________________________________ Language: __________________________________________________ ● Which language(s) does your child use? Language: ___________________________________________________ How often? (circle one) sometimes often always 0% -‐ 25% 25%-‐75% 75% -‐ 100% Language: ___________________________________________________ How often? (circle one) sometimes often always 0% -‐ 25% 25%-‐75% 75% -‐ 100% X __________________________________________________________________________ __________/__________/_______________ Parent/Guardian Signature Date (mm/dd/yyyy) -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐ For Office Use Only: If a language other than English is listed in any area on the HLS, please fill-in the approximate start date below and forward this form to the attention of: ELL Testing & Placement Coordinator ~ Student Services. Start Date in Hopkinton: ________/________/20_______ Eligible for ELL Services? No ▢ Yes ▢ ELL Screening Date: ________/________/20_______ WIDA Scores L:________ S:________ R:________ W:________ Overall:________ HLS-Revised 2014 General Information On Fee-Based Busing
2015-2016 School Year
In accordance with the updated Student Transportation Policy of the Hopkinton Public
Schools/Hopkinton School Committee the following information applies to fee-based school bus
transportation for the 2015-16 school year:
•
Fee based busing is available to students who are either in grades K-6 and live less
than two miles from their assigned school, or are in grades 7-12 in which all students
pay for busing.
•
Payments for the Fee-Based Busing Program are to be received (or postmarked) by
Friday, May 1, 2015. The cost for a bus pass for the 2015-16 school year is $155 per
student with a family cap of $310.
•
Grace period: Payments received (or postmarked) between May 2 & June 30, 2015, will
be subject to late fees, but will be guaranteed an assignment to a bus that serves your
residential area. The late bus fee for the 2015-16 school year is $235 per student with a
family cap of $470.
•
Payments received (or postmarked) after June 30, 2015 (after the grace period) will incur
a late fee; will be wait-listed and will not be guaranteed assignment to a bus for the first
two weeks of school; if space is not available on a bus that serves your residential area
your student will be offered an alternative bus at the next closest bus stop to his/her home;
and new bus stops will not be created to accommodate late applicants.
•
Incoming Kindergarten students for the 2015-16 school year will receive a mailing from
Center School in early April which will contain busing information. The busing application
deadline for incoming kindergarten students is Friday, May 1, 2015.
•
Students new to the school district, and who register/enroll for school after May 1, pay the
standard bus fee of $155 per student, with a family cap of $310.
Payment Options
•
On-line payments may be made via a secure on-line payment center provided by UniBank.
A link is located on the Hopkinton Public Schools website (www.hopkinton.k12.ma.us)
under Transportation. Payments made directly from a checking account, or by credit/debit
card, are assessed a fee by Unibank. Only Discover and MasterCard are accepted by
Unibank. Visa cards are not accepted. To pay on-line, you will need your child’s five-digit
ID number. This number appears on all report cards and progress reports, and can be
found on IPass. If you cannot locate this number, it can be obtained by contacting your
child’s school. Your online payment serves as the transportation application for the
student(s) designated; you do not have to submit a paper application.
•
Payments made by mail should be made via check or money order made payable to
“Hopkinton Public Schools-Bus Fee”. Please do not send cash. Payments must be
accompanied by a completed 2015-16 School Bus Transportation Application and should
be sent to: Hopkinton Public Schools, Transportation, 89 Hayden Rowe Street, Hopkinton,
MA 01748.
•
Please note that installment payments are not allowed. The bus fee will not be prorated for
one-way trips, nor will it be prorated for occasional use. Refunds and late purchase
amounts are determined based on the schedule at the end of this document.
•
The School Committee continues to offer a Financial Assistance program which provides
full and partial waivers of most school fees including the bus fee. Details of this program
can be found on our website www.hopkinton.k12.ma.us, on the Homepage, under Site
Shortcuts, Financial Assistance. This confidential financial assistance waiver form is easy
to complete and should be sent along with your 2015-2016 School Bus Transportation
Application. The deadline for completed Financial Assistance application is also
May 1, 2015. If you have difficulty locating the application on the website please call or
email us and a paper copy will be mailed to you. Free and Reduced Lunch applications
are not used to determine free bus pass eligibility.
Other Information
•
Updated Childcare Transportation procedures, requirements, and Transportation
Arrangement forms for the 2015-16 school year are being sent home in April via student
backpacks for students currently in elementary grades K-4.
Incoming Kindergarten Childcare Transportation Arrangement forms and childcare
transportation information for the 2015-16 school year will be mailed home in April from
Center School.
This information can also be found on the district website under Transportation.
•
Bus passes will be mailed to your place of residence during the last week of August. All
students will be required to present their bus pass to the bus driver beginning with the first
day of school. Please note: No bus passes will be available for pick-up at the
Transportation Office during the summer months through September 11, 2015, as
staff must follow a process of determining bus space availability before a pass can
be printed.
•
The two (2) mile limit for determining the bus fee for grades K-6 is determined using a
Geographic Information System (GIS) provided by the Massachusetts Highway
Department. These distances are based on the distance from your home address to your
child’s school. Distances from childcare locations are not relevant. If you have any
questions about distances, please contact us.
•
Bus switching is not allowed on a day-to-day basis for Grades K-5.
•
Bus stop switching is allowed for grades K-5 on a student’s assigned bus by sending a
Note from Home to your student’s school on the day the bus stop switch is to be made.
(see Bus Stop Switching Procedures-Elementary Schools on the HPS Transportation
webpage)
•
Bus switching is allowed for grades 6-12 on afternoon (PM) buses for students with a
valid bus pass. Morning (AM) bus switching is NOT permitted. Students who are
switching buses must wait for all students with passes for that number bus to board first
then may board if there are seats available. A valid bus pass must be shown to bus
switch. Bus switching is not allowed on early release days. Bus switching will start on
Monday, September 21, 2015, the third full week of school.
•
Valid bus passes may be swapped permanently for a Senior or Junior parking spot
during the school year, at the High School, by filling out a HS parking spot application,
attaching the valid bus pass instead of a check, and submitting both to Officer Phil. With
the surrender of the bus pass for a parking spot, the student is no longer eligible to ride
school buses.
•
Replacement bus passes can be purchased for a $5.00 fee at the Transportation office.
Questions regarding transportation should be directed to Mary Ann Fitzpatrick on 508-4179381 or emailed to: [email protected].
Purchase/Refund Schedule
Purchase
September through December
100%
January through March
75%
April through end of school
50%
The additional $80.00 fee assessed after May 1, 2015, is not refundable.
Refund
50%
25%
0%
Rev. 3/12/15
HOPKINTON PUBLIC SCHOOLS
2015- 2016 SCHOOL BUS TRANSPORTATION APPLICATION
I wish to arrange fee based school bus transportation for my student(s) for the 2015-2016
school year. I understand that only students in grades K-6 who live two (2) miles or more from
their assigned school are eligible for town paid (free) transportation. I further understand that
available seats will be filled on a first-come first-served basis and that submission of this
application does not guarantee a seat.
Please list all students you are paying for on this form. ONLY ONE FORM PER FAMILY IS
NECESSARY. All information must be completed in full.
Parent/Guardian Name:
Telephone No.
Address:
Email:
Student Name(s):
Last
First
Grade for
2015/2016
School
Comments
Application and full payment of $155.00 per student, with a cap of $310.00 per family,
must be received (postmarked) by May 1, 2015. The fee will increase to $235.00 per
student, with a cap of $470.00 per family after May 1, 2015.
Students new to the school district, who register/enroll after May 1, 2015, pay the
standard bus fee of $155/student, $310/family.
All students must have a bus pass in order to board their bus on the first day of school.
Enclosed $__________________________ Check #__________________________________
Check or Money Order (please, no cash) should be made payable to the Hopkinton Public
Schools – Bus Fee. Mail to: Hopkinton Public Schools, Transportation, 89 Hayden Rowe
Street, Hopkinton, MA 01748. Questions may be emailed to:
[email protected].
Per Transportation Policy EEA:
Bus Application Grace Period: Payments received (or postmarked) between May 2 & June 30, 2015, will be subject to
late fees, but will be guaranteed an assignment to a bus that serves your residential area with a standard bus stop.
Payments received (or postmarked) after June 30, 2015 (after the grace period) will incur a late fee; will be wait-listed
and will not be guaranteed assignment to a bus for the first two weeks of school; if space is not available on a bus
that serves your residential area your student will be offered an alternative bus at the next closest bus stop to his/her
home; and new bus stops will not be created to accommodate late applicants.
____________________________________________________________________________
FOR OFFICE USE ONLY:
DATE RECEIVED: _________________
Childcare Transportation
2014-15 School Year
In accordance with the updated Student Transportation Policy (EEA) of the Hopkinton Public Schools/
Hopkinton School Committee the following information applies to childcare transportation for the 2014-2015
school year.
Transportation to and from childcare locations is permitted under the under the following conditions:
•
•
•
•
•
The Childcare Provider has contracted with Hopkinton Public Schools (HPS) for transportation service
for the 2014-15 school year.
A designated sitter location is the residence of a “familial sitter” (family relation).
The childcare location(s) designated are continuous throughout the 2014-15 school year
The bus has available space
School notification of the student’s childcare provider(s), via the Transportation Arrangement Form is
received by the schools by the following dates:
Hopkins and Elmwood Schools: May 15, 2014
Center School: Students entering 1st Grade: May 15, 2014
Incoming Kindergarteners: Information will be mailed home during the last week in April. The
deadline for the return of Childcare Arrangement forms for Incoming Kindergarteners is May 15, 2014
For all presently enrolled students: if new, or requested changes to childcare transportation are submitted
after May 15, 2014:
• A busing accommodation cannot be guaranteed.
• Requests are to be submitted on a Change of Childcare Transportation Request form along with a
new Transportation Arrangement form. These requests can only be considered in emergency or
extenuating circumstances.
• There will be a freeze on all requests for childcare transportation adds or changes from July 18September 19, 2014. New and change requests submitted during this time period will be held for
review until after 9/19/14.
• Transportation to and from childcare will be the responsibility of the parent until such time as the
request is approved.
Students new to the school district, who enroll/register after May 15, 2014, are required to submit their
Childcare Transportation Arrangement form within a week of registration.
Therefore, if you have not yet solidified your childcare plans for the 2014-15 school year, we urge you to do
so. Please communicate your plans to your student’s assigned school by the dates noted above.
PLEASE NOTE: For students in grades K-5, no day-to-day bus switching is allowed. Requests for exceptions
to your childcare transportation arrangements can only be considered in emergency and/or extenuating
situations via a note to the School. Notes to the Schools regarding busing are to be sent on a NOTE FROM
HOME sold by the HPTA or found on the district website under Transportation. Due to safety concerns, bus
drivers and classroom teachers are not permitted to make busing changes.
The Schools are committed to doing everything in their power to help children to navigate to the correct bus
for transportation to childcare, but it is the child, rather than the school staff and bus driver, who is responsible
for getting him/herself to the correct bus.
Questions regarding this notification can be directed to Mary Ann Fitzpatrick on (508) 417-9381 or emailed to
[email protected].
Ralph O. Dumas,
Director of Finance
4/9/14
TRANSPORTATION ARRANGEMENTS 2014-15
Grades K-5
• For Grades 1-5, please submit this form ONLY if your child will be picked-up or dropped-off at a
location (Childcare Provider, Sitter, at School for Parent Transport) other than your home address,
before or after school, on a permanent weekly basis.
• For K students, all families are to fill out this form, even if your child is traveling by bus to/from home.
• For Grades 2 & 3 at Elmwood School, please also submit this form if your child will attend the
afterschool program at Kidsborough-Elmwood School on a permanent weekly basis.
STUDENT’S NAME:_______________________________2014-15 GRADE:_______
STUDENT’S HOME ADDRESS:___________________________________________
HOME PHONE #:__________________________CELL #______________________
EMAIL:_____________________________________________________________
2014-15 Childcare Transportation Policy Notes
Per Student Transportation Policy (EEA), updated 2/27/14:
For students in grades K-5, no day-to-day bus switching is allowed.
Parent(s)/Guardian(s) may request one additional pick-up location and one additional drop-off location
in addition to their home address. The additional pick-up and drop-off addresses do not need to be the
same and can occur on as many days as necessary.
Transportation to and from childcare locations is permitted under these conditions:
•
•
•
•
The Childcare Provider has contracted with HPS Transportation for the 2014-15 school year to
provide busing service to their place of business
A designated sitter location is the residence of a “familial sitter” (family relation)
The bus serving the childcare provider has available space
The childcare locations are continuous throughout the school year and at an approved bus stop
BUS PICK-UP ADDRESS:
BUS DROP-OFF ADDRESS:
Monday:_______________________________
Monday:___________________________
Tuesday:_______________________________
Tuesdays:__________________________
Wednesday:____________________________
Wednesday:________________________
Thursday:______________________________
Thursday:__________________________
Friday:_________________________________
Friday:_____________________________
Childcare Provider:____________________________ Phone #___________________________
Address:_______________________________________________________________________
For Sitter: Designate family relationship_____________________________________________
Childcare Provider:____________________________ Phone #___________________________
Address:_______________________________________________________________________
Per updated Student Transportation Policy (EEA), I expect that this arrangement will be continuous for
the 2014-15 school year. I understand that in the future, any request for change will be subject to
review and may take up to 2 weeks.
Date:_________________ Parent/Guardian Signature_________________________________________
Hopkinton Public Schools
89 Hayden Rowe Street Hopkinton, MA. 01748
Telephone: 508-417-9360
Fax: 508-497-9833
Release of Information and Open Communication
Name: _________________________
School: _________________________
D.O.B. ____________________________
Grade: ___
Parent/Guardian: ____________________
School Address: ______________________________________________________________________
School Phone number: ____________________
Send to
Receive from
School Fax number: ___________________
Exchange with
Verbal Exchange
Information regarding the above named student.
____________________________________
____________________________________
____________________________________
____________________________________
Information to be released:

Administrative Records (e.g. name, address, birth date, grade level, class standing and attendance)
Standardized Achievement Test Scores
Intelligence and Aptitude Test Scores
Interest Test Scores
Teacher and Counselor Observation and Ratings
Record of Extracurricular Activities
Special Education Records (IEP, Evaluation Report, etc.)
All of the above as appropriate
Other ________________________________________________
Specify
I give my permission for information and records to be shared between the Hopkinton Public Schools, and
the above mentioned person, agency or district.
_______________________________________________
Parent/Guardian
____________________________
Date
________________________________________________
Student’s Signature (if 18 or older)
______________________________
Date
HOPKINTON PUBLIC SCHOOLS
Student Image (Photo/Video) Restriction Form
During the year, we often take images including still photographs or live videos of students,
parents, teachers, and school activities. We may include these images on school bulletin boards,
in school and HPTA publications, in newspapers, newscasts, and/or on our school and district
web sites. (Students’ addresses and phone numbers are not included with any information posted
on the web site.)
If you DO NOT want your student’s image to appear in these public places, please complete the
form below, sign it, and return it to school by September 18th. This form does not need to be
returned if you wish to allow your student’s/your image to appear in school and HPTA
publications including the web site, newspapers, newscasts, and bulletin board displays and web
sites.
If you wish to indicate a partial or qualified restriction, please state specifics in a separate, signed
letter to the Principal.
This policy shall not limit the right to publish images of any student participating in school
sports, school plays or concerts or other activities in the public domain.
I do not want my student’s image to appear on school bulletin boards, in school and HPTA publications, in
newspapers, newscasts, and on web sites.
School Year:
Student’s Name:
Date:
School:
Home Address:
Parent Signature:
For Students 18 Years Old or Older:
I do not want my picture to appear on school bulletin boards, in school and HPTA publications, in local
newspapers, and on web sites.
Your Name (Please print):
Your Signature:
Date:
For more information on this School Committee policy, please see policy JRD
(www.hopkinton.k12.ma.us/schoolcommittee/policies.html) or obtain a copy of this policy and additional
information from the Principal.
RETURN ONLY TO STOP PUBLICATION OF PHOTOS
Hopkinton Public Schools
MCAS Information Sheet
Student Name:__________________________________Entering Grade Level______
Dear Parents/Guardians:
All students attending public schools in Massachusetts are required to attain a proficient
or advanced score on the MCAS Exams (Massachusetts Comprehensive Assessment
System). Students tested in Grade 10 must show proficiencies in these subject areas:
English Language Arts, Mathematics and Science in order to receive a high school
diploma.
If your son/daughter is transferring from a MA public school have they taken
MCAS?
ELA
Math
Science- which subject area___________________________
If your student is transferring from a private, out of state, or out of country school,
they are required to take the exam at the next testing period if they plan to graduate
from Hopkinton High School.
Prior school:_________________________________________
Address:_____________________________________________
Phone #:_____________________________________________
_________________________________
Signature Parent/Guardian
______________________
Date
There are no exceptions to this requirement if the student is planning to receive a
diploma upon graduation from Hopkinton High School.
For Office Use Only
Testing Dates:___________________________
Appropriate Science: _____________________
ELA:____________________________________
MATH:__________________________________
Copies to MCAS Coordinator, Counselor, Science Department Coordinator