TEANECK PUBLIC SCHOOLS 651 Teaneck Road Teaneck, New Jersey 07666 www.teaneckschools.org

REGISTRATION FORM FOR SCHOOL YEAR 2023-2024

MANDATORY REGISTRATION / RESIDENCY REQUIREMENTS

Registration and residency forms are to be completed and submitted to the Teaneck Board of Education Central Registration Office. You can send via email to registrar@teaneckschools.org or make an appointment to drop off documentation at the Registration Office located at 651 Teaneck Road. Registration Office hours vary by time of year, please call (201) 833-5512 to confirm hours.

Regular Registration Office hours are as follows: Monday through Friday 9:00 a.m. – 3:30 p.m.
(The office will be closed for lunch from 12:00 p.m. to 1:00 p.m.)

For evening appointments, please contact the registrar at (201) 833-5512 or via email at registrar@teaneckschools.org.

If you have a question regarding residency or registration requirements, please contact Ms. Rose Antinori, Registrar at (201) 833-5512 or via email at registrar@teaneckschools.org.

The following documents will be accepted for consideration at the time of registration: (All documents must be officially translated in English)

A. Original Birth Certificate (Passport can be used to establish official date of birth if birth certificate is not available).

B. Record of Immunization. New Jersey State Law prohibits students from entering school without a Record of Immunization. Documentation must have the student’s legal name.

C. Proof of Residency – See page 7 for list of acceptable proof of residency.

D. Name and address of previous school.

E. Custodial documents if applicable.

F. Special Services Records Release form – only if student has an IEP/ISP.

The school’s secretary will contact the parent/guardian to schedule an appointment to finish the enrollment.

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TEANECK PUBLIC SCHOOLS 651 Teaneck Road Teaneck, New Jersey 07666 www.teaneckschools.org

Skyward Family Access Parental Use and Responsibility Acknowledgement

Skyward Family Access is a web-based application that allows you to track information regarding your child’s progress for the current year. You may access this program by connecting to our secured server to view assignments, attendance, report card grades, and other school information.

I, ______________________________________________________________________________________, (parent/guardian name)

Parent/Guardian of ________________________________________________________________________ (student name)

acknowledge that I have requested and received authorization to use Skyward Family Access. I understand that I share in the responsibility of keeping safe the data of my child(ren). My responsibilities include reporting any security concerns to the school district, guarding my password, changing my password on a regular basis, and promptly logging off of my Skyward Family Access session when finished or before leaving my computer. I understand that the school district may without prior notification disable my accounts as part of the overall security procedures.

_________________________________ Print Parent/Guardian Name

x____________________________________ Signature of Parent/Guardian Name

Date: ____________________________

NAME OF PARENT/LEGAL GUARDIAN WHO ARE ALLOWED FAMILY ACCESS

	

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TEANECK PUBLIC SCHOOLS 651 Teaneck Road Teaneck, New Jersey 07666 www.teaneckschools.org

TEANECK PUBLIC SCHOOL DISTRICT

Registration Office

651 Teaneck Road, Teaneck,

registrar@teaneckschools.org

(201) 833-5512

CONSENT TO REGISTER STUDENT

I ________________________________________certify that I am the child’s legal guardian or court (Parent/Guardian) authorized official and hereby consent for the child to be enrolled in the Teaneck Public School District.

I understand that the Teaneck Board of Education will verify the statements in this application and false statements could subject me to tuition and transportation charges.

I also understand that it is my responsibility to immediately notify the school of any changes in circumstances affecting the information set forth herein.

__________________________________ Parent/Guardian Signature

__________________________________ Parent/Guardian Signature

________________ Date

________________ Date

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TEANECK PUBLIC SCHOOLS 651 Teaneck Road Teaneck, New Jersey 07666 www.teaneckschools.org

TOP PORTION TO BE COMPLETED BY TEANECK PUBLIC SCHOOL PERSONNEL
SKYWARD ID:
	REGISTRAR:
	REGISTRATION DATE:
	Supt Approval ☐

HL	☐

Non Eng ☐

504     ☐
	
ENTRY CODE:
	SE PK: ☐	Evaluation requested: ☐
		
GRID CODE(ELEM/MS):
	IEP: ☐	Evaluation requested: ☐
		
GUARDIANSHIP: Court Order submitted
YES ☐ NO☐
	GUARDIANSHIP: BOE Affidavits submitted YES ☐ NO☐

BOTTOM PORTION OF PACKET TO BE COMPLETED BY PARENT/GUARDIAN STUDENT INFORMATION

If you are claiming to be an emancipated student, are you living independently in your own permanent home in the district? YES ☐     NO ☐

Has the student ever been enrolled in the Teaneck School system? Yes ☐	No ☐

Has the student ever been enrolled in a New Jersey school system? Yes ☐	No ☐

STUDENT FIRST NAME (As on birth certificate)
	STUDENT MIDDLE NAME
	STUDENT LAST NAME
	GENDER M	☐
F	☐
	School Year 23-24 GRADE:
	
STUDENT’S HOME ADDRESS
	CITY
	STATE
	ZIPCODE
	
STUDENT’S MAILING ADDRESS (if different from home address)
	CITY
	STATE
	ZIPCODE
	
NAME OF PARENT(S)/GUARDIAN
	PRIMARY/HOME NUMBER (preferred contact number)
	
PERSON ENROLLING STUDENT
	TELEPHONE NUMBER
	RELATIONSHIP TO STUDENT
	
In accordance with required Federal Standards [See 1997 Standards, 62 FR 58789 (October 30, 1997)], educational institutions are required to collect racial and ethnic data in the following manner:

Ethnicity(must check one)	☐ Hispanic	☐ Non-Hispanic

Hispanic or Latino means a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. The term “Spanish origin” can be used in addition to “Hispanic/Latino or Latino.”

Race (must check one)	☐ White ☐ Black/African Amer ☐ Amer Indian/Alaskan Native ☐ Asian ☐ Native Hawaiian/Pacific Islander

(1) American Indian or Alaska Native. A person having origins in any of the original peoples of North and South America (including Central America), and who maintains a tribal affiliation or community attachment.
(2) Asian. A person having origins in any of the original peoples of the Far East, South East Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine islands, Thailand, and Vietnam.

(3) Black or African American. A person having origins in any of the Black racial groups of Africa.
(4) Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

(5) White. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

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TEANECK PUBLIC SCHOOLS 651 Teaneck Road Teaneck, New Jersey 07666 www.teaneckschools.org

BIRTHDATE
	AGE
	CITY OF BIRTH
	STATE OF BIRTH
	COUNTRY OF BIRTH
	
First Entry Date into a U.S. School: (if student is born outside of the U.S.)
	Language Spoken by Child?
	Native Language Spoken by Child?
	Home Language?
	Did student attend an ESL class in previous school?
	
NAME AND ADDRESS OF LAST SCHOOL STUDENT ATTENDED

SCHOOL NAME:____________________________________________________________

ADDRESS:_________________________________________________________________

___________________________________________________________________________
	GRADESTDUENT WAS IN PREVIOUS SCHOOL:
	
	DATE OF LAST DAY OF ATTENDANCE IN PREVIOUS SCHOOL:

FAMILY 1 INFORMATION – PARENT/GUARDIAN LIVING IN THE SAME HOUSEHOLD

Parent/Guardian #1 - Relationship to Student: Mother ☐	Father ☐	Legal Guardian ☐	Foster Parent ☐ Emancipated ☐
	
First Name
	Middle Name
	Last Name
		Title
	
Home Address
	
Primary/Home Telephone
	Cell/Alt Phone
	Email Address
	
Employer
	Work Telephone	Ext
	
☐Resides With Student	☐Allow Web Access

Parent/Guardian #2 - Relationship to Student: Mother ☐	Father ☐	Legal Guardian ☐ Foster Parent ☐ Step-Parent ☐               DCP&P ☐
	
First Name
	Middle Name
		Last Name
	Title
	
Home Address
		
Primary/Home Telephone
	Cell/Alt Phone
	Email Address
	
Employer
	Work Telephone	Ext
	
☐Resides With Student	☐Allow Web Access

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TEANECK PUBLIC SCHOOLS 651 Teaneck Road Teaneck, New Jersey 07666 www.teaneckschools.org

FAMILY 2 INFORMATION – IF PARENT/GUARDIAN IS LIVING SEPARATELY

Parent/Guardian #1 - Relationship to Student: Mother ☐	Father ☐	Legal Guardian ☐ Foster Parent ☐ DCP&P
	
First Name
	Middle Name
	Last Name
	Title

Mailing Address

Primary/Home Telephone
	Cell/Alt Phone
	Email Address
	
Employer
	Work Telephone	Ext
	
☐Extra Mailings	☐Contact Not Allowed	☐Allow Web Access	☐ Receive Hard Copy of Report Card

☐ Receive email/phone notification

Please list any siblings currently attending or will be attending Teaneck Public Schools

Siblings
	Grade
	Gender
	Age
	School

					

					

EMERGENCY CONTACT INFORMATION

First Contact
		
Name
	Phone
	Relationship
	
Second Contact
	
Name
	Phone
	Relationship
	
Third Contact
	
Name
	Phone
	Relationship

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TEANECK PUBLIC SCHOOLS 651 Teaneck Road Teaneck, New Jersey 07666 www.teaneckschools.org

Mark the forms of proof you are providing to demonstrate your physical address.

Refer to Options 1-4 below;
Property Tax Bill, Tax Assessment Card, or Recent Mortgage Statement and utility bill Copy of Deed and utility bill
Copy of Current Lease Agreement and utility bill Affidavit of Landlord – see option 3 or 4

1. Does Parent/Guardian OWN or RENT home address: _______________________________________________

2. If Mother/Father of applicant/student lives in a separate household:

Reason:	Divorced	Separated	Other:_________________________________________

Address:___________________________________________________________________________________

3. Is there a custodial court order or written agreement designating the district for school attendance?
YES	NO	If yes, please submit a copy of the written agreement to this form at the time of registration.

4. Does the student reside with one parent for the entire year? YES       NO         If so, with which parent at what address:________________________________________________________ __________________________

5. If the student does not reside with one parent for the entire year, explain the portion of time the student resides with each parent and at what addresses. ___________________________________________________________________ ______________________________________________________________________________________________
	ACCEPTABLE PROOF OF RESIDENCY
		
OPTION 1: IF YOU OWN A HOME
1. Please provide a copy of your current property tax bill, tax assessment card, a copy of your deed or a recent mortgage statement.
AND
2.	 Most recentutilitybill (i.e. PSE&G,water company, cable, telephone bill).
	OPTION 2: IF YOU LEASE
1. Please provide a current copy of your lease and it must include the name of the parent/guardian.
AND
2.	 Most recent utility bill (i.e. PSE&G, water company, cable, telephone bill).
	
OPTION 3: IF YOU RENT AND DO NOT HAVE A LEASE
1. You must have the owner/landlord of the property complete an Affidavit of Landlord form. The owner of the property must sign the form and have it notarized .
AND
2. The owner must provide a copyof the current propertytax bill, tax assessment card, a copy of the deed, or a recent mortgage statement.
AND
3. Copy of your (Parent/Guardian) most recent utility bill (i.e. PSE&G, water company, cable, telephone bill).
	OPTION 4: IF IT IS A PRIVATE HOME AND YOU DO NOT PAY RENT
1. You must have the owner/landlord of the property complete an Affidavit of Landlord form. The owner of the property must sign the form and have it notarized . You do not need to disclose any rent amount on the form.
AND
2. The owner must provide a copy of their current property tax bill, tax assessment card, a copy of the deed, or a mortgage statement.
AND
3.The parent/guardian must provide a copyof a current utility bill (i.e. PSE&G, water company, cable, telephone bill) or any bill that shows the Teaneck address.

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TEANECK PUBLIC SCHOOLS 651 Teaneck Road Teaneck, New Jersey 07666 www.teaneckschools.org

AFFIDAVIT OF LANDLORD

STATE OF NEW JERSEY) SS:
COUNTY OF BERGEN	)

I _____________________________________ of full age, and being duly sworn upon his or her oath,

according to law, deposes and says:

1. I am the owner of property located at _____________________________________________, in the Township of Teaneck.
2. ____________________________________ is a tenant and has been a tenant at the above premises since ______________(month/day/year). A copy of this tenant’s lease, if same is in written form, is attached hereto. In the event that tenant does not have a written lease, the pertinent terms of said lease are as follows:
A. Circle one of the following: Month to Month / Year to Year B. Rental amount $ _______________ per ______________ C. The names of permissible tenants are as follows:

1. ____________________________ 2. ____________________________
3. ____________________________

4. _______________________________ 5. _______________________________
6. _______________________________

3. I am making this affidavit knowing that the Board of Education of the Township of Teaneck will rely on same in determining whether ________________________________ will be considered a pupil who is entitled to an education free of charge.

I understand that if any of the statements made by me are willfully false that I am subject to punishment.

____________________________________ (LANDLORD)
Sworn and subscribed before

me this _______ day of ________

__________________________ (A Notary Public)

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TEANECK PUBLIC SCHOOLS 651 Teaneck Road Teaneck, New Jersey 07666 www.teaneckschools.org

STUDENT NAME: ___________________________________ DOB:_____________ AGE:____     GRADE:_____	IEP: YES ☐	NO ☐

PARENT/LEGAL GUARDIAN: ___________________________________________________ PHONE: ________________________

LAST PERMANENT PLACE OF RESIDENCY IN NJ:

ADDRESS:________________________________________________________________________

CITY, STATE, ZIP CODE:____________________________________________________________

Number of years/months at last permanent address: ____________________________________

Move in date: _______________________	Move out date: _________________________

LAST SCHOOL ATTENDED: __________________________________________________________ GRADE AT LAST SCHOOL:________

LAST PERMANENT PLACE OF RESIDENCY OUT OF STATE:

ADDRESS:________________________________________________________________________

CITY, STATE, ZIP CODE:_____________________________________________________________

Number of years/months at last permanent address: ____________________________________

Move in date: ___________________________ Move out date: _____________________________

LAST SCHOOL ATTENDED: ___________________________________________________________ GRADE AT LAST SCHOOL:________

STUDENT IS PRESENTLY: ☐ IN A SHELTER	☐ IN A MOTEL/HOTEL ☐ DOUBLED UP WITH FAMILY/FRIENDS ☐ KNOWN TO DCP&P

OTHER _______________________________________

CURRENT PHYSICAL LOCATION OF STUDENT RESIDENCE: ______________________________________________ AS OF ______________

RESIDENCE STATEMENT: _______________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

Under penalty of perjury under the laws of this state, I declare that the information provided here is true and correct and of my own personal knowledge

and that, if called upon to testify, I would be competent to do so. I also understand that I must notify the Teaneck Public School District of any changes

as soon as they occur. I give my approval for this document to be shared with the District McKinney-Vento Liaison.

Parent/Guardian signature: X________________________________ Date X_______________

Parent/Guardian print name: _________________________________________________

OSS: ___________________________Date_________

FOR OFFICE USE ONLY ELIGIBLE UNDER MC KINNEY-VENTO:     ☐ YES	☐ NO

RESIDENCY:__________________________________________________________________________________________________________________________________________

DISTRICT OF RESPONSIBILITY:__________________________________________________________________________________________________________________________

NOTIFICATION SENT TO:	☐ SCHOOL PRINCIPAL	☐ BUSINESS ADMINISTRATOR	☐ DIRECTOR OF SPECIAL SERVICES	☐ McK-V COUNTY LIAISON

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TEANECK PUBLIC SCHOOLS 651 Teaneck Road Teaneck, New Jersey 07666 www.teaneckschools.org

HOME LANGUAGE SURVEY Parent/Guardian Questionnaire

PLEASE PRINT

This home language survey is to be completed at the time of registration by all who are registering within the Teaneck School District. The information provided is used to determine if another language is spoken in the home. The questions should be completed by the primary caregiver (with translators available, if and when needed).

Child’s name: _________________________________________________________ Date: __________ (first)	(middle)	(last)

Child's Date of Birth: ____________________________________________

Person completing the survey: ☐ Mother	☐ Father	☐ Grandparent	☐ Guardian	☐ Other

Please tell us about your child:

1.	What language did the child learn when he/she first began to talk? __________________________

2.	What language does the family speak at home most of the time? ____________________________

3.	What language(s) does the primary caregiver (s) speak to the child most of the time? ____________

4.	What language(s) does the child speak to his/her primary caregiver (s) most of the time? _________

5.	What language(s) does the child speak to his/her brothers and sisters most of the time? __________

6.	What language does the child speak to his/her friends most of the time? _______________________

7.	In which language do you wish to receive information from the school? _______________________

8.	What name do you use for your child (if different from above)? _____________________________

Sources:
Questions 1 – 8 are based on the NJ DOE Home Language Survey that was adapted from the sample survey in A Manual for Community Representatives of the Title VI Steering Committee, published 9/76 by the Institute for Cultural Pluralism, Lau General Assistance Center, San Diego University, San Diego, CA 92182

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TEANECK PUBLIC SCHOOLS 651 Teaneck Road Teaneck, New Jersey 07666 www.teaneckschools.org

**PLEASE MAKE SURE TO – CHECK ANSWER AND
	INITIAL ALL QUESTIONS
	--
	ON THE LINE AFTER**

 SPECIAL SERVICES:	

Has your child ever been referred for a special education evaluation? Yes ☐ No ☐ ___________

Has your child ever been evaluated by a special education child study team? Yes ☐ No ☐ ___________

Has your child ever been classified for special education/related services or for speech services? Yes ☐ No ☐ _______

Do you have any reason to suspect that your child may have a learning, emotional or physical issue? Yes ☐ No ☐

____
Student has an IEP (Individualized Education Program:	Yes ☐ ___________	No ☐ ___________

Parent/Guardian provided copy of IEP: Yes ☐ No ☐ ___________

Referred by Teaneck Case Manager: Yes ☐ No ☐	Teaneck Case Manager Name: _____________________________

Referred to Special Services by Registrar: Yes ☐ No ☐ ___________ If no, why? _______________________________

SPECIAL SERVICES:

Student has an ISP (Individualized Service Plan): Yes ☐ ___________	No ☐ ___________

Parent/Guardian provided copy of ISP: Yes ☐ No ☐ ___________

Referred by Teaneck Case Manager: Yes ☐ No ☐	Teaneck Case Manager Name:_______________________________

Referred to Special Services by Registrar: Yes ☐ No ☐ ___________

SPECIAL SERVICES:

Has your child ever had a 504 Accommodation Plan: Yes ☐ No ☐ ________

Student has a 504 Accommodation Plan:	Yes ☐ ___________	No ☐ ___________

Parent/Guardian provided copy of 504 Accommodation Plan: Yes ☐ No ☐ ___________

Referred by Teaneck Case Manager: Yes ☐ No ☐	Teaneck Case Manager Name:_________________________________

Referred to Special Services by Registrar: Yes ☐ No ☐ ___________

SPECIAL SERVICES

Early Intervention by NJ state: Yes ☐ No ☐

Do you have a meeting with a case manager: Yes ☐ Date of meeting: ________________	No ☐

Referred by Teaneck Case Manager:	Yes ☐ No ☐	Teaneck Case Manager Name: Referred to

Special Services by Registrar: Yes ☐ No ☐

Parent/Guardian signature: x_______________________________________ Date: ___________

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TEANECK PUBLIC SCHOOLS 651 Teaneck Road Teaneck, New Jersey 07666 www.teaneckschools.org

***IMPORTANT***

The school’s secretary will contact the parent/guardian to schedule an appointment to finish the enrollment.

Grades PreK - Kindergarten
	Grades 5-8

(PreK)
Bryant Elementary School One Tryon Avenue
David Deubel, Principal
Contact: Connie Le, Secretary - (201) 833-3976 or Venessa Watt-St. Clair, Secretary - (201) 833-5545
(K)
Theodora Smiley Lacey Elementary School One Merrison Street
Leslie Abrew King, Principal
Contact: Chanon McDuffie, Secretary - (201) 862-2508 or Yennifer Nuñez, Secretary - (201) 862-2509
	
Benjamin Franklin Middle School 1315 Taft Road
Terrence Williams, Principal Jahari Jacobs, Assistant Principal
Marina Williams Assistant Principal Gulshir Khan, Secretary - (201) 833-5451
Contact: Jennifer Henry, Guidance Secretary - (201) 833-5455

Thomas Jefferson Middle School 655 Teaneck Road
Nina Odatalla, Principal Nicholas DeBlasio, Assistant Principal
Ramon Ortiz, Assistant Principal
Gina Geronimo, Secretary - (201) 833-5471
Contact: Nicole Fernandez, Guidance Secretary (201) 833-5475
	
Grades 1-4
	Grades 9-12

Whittier Elementary School 491 West Englewood Avenue Piero LoGiudice, Principal
Contact: Susan DeLisio, Secretary - (201) 833-5535

Hawthorne Elementary School 201 Fycke Lane
Natasha Pitt, Principal
Contact: Dawn Santamaria, Secretary - (201) 833-5540

Lowell Elementary School 1025 Lincoln Place
Antoine Green, Principal Contact: Karen Munoz - (201) 833-5550
	
Teaneck High School 100 Elizabeth Avenue
Pedro H. Valdes III, Interim Principal Margot Mack, Assistant Principal Justin O’Neill, Assistant Principal
Contact: Kim Dockery, Guidance Secretary - (201) 833-5426

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