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Maine-Endwell UPK Lottery Registration Form 2024-2025

Welcome to Maine-Endwell Central School District,

The online registration process will give us the initial information we need to enroll your student. During this process you will be asked to securely upload the following documents that are needed for registration:

Birth Certificate or Passport

(2) Proofs of Residency forms (mortgage, rental agreement, utility bill)

Proof of Immunizations AND most updated Health Examination

Dana Calandra

Director of UPK, dcalandra@me.stier.org

Registration Assistance

For technical assistance or any other questions, please contact our registrar at registration@me.stier.org. If you would like to book an in person appointment with our registrar, please schedule it by using the link below:

Schedule In Person Registration Appointment

Thank you for enrolling at Maine-Endwell Central School District. We look forward to meeting you.

Student's last name *

Student's first name *

Student's middle name *

Student's date of birth *

Student's gender *

Male

Female

Non-Binary

Is the student Hispanic? *

Yes

Student's race: *

White
American Indian
Alaskan Native
Asian
Black or African American
Native Hawaiian / Other Pacific Islander

Primary language *

Is there a second language spoken in your home? If yes, please list the language. *

What languages does your child understand? *

What language do you need to receive school information in? *

Primary contact's first name *

Primary contact's last name *

Primary contact's relationship *

Mother

Father

Other

Primary contact's email *

Primary contact's cell phone number *

Primary contact's home phone number *

Primary contact's work phone number

Employer: *

Primary contact's house number *

Primary contact's street name *

Primary contact's unit number

Primary contact's city *

Primary contact's state *

Primary contact's ZIP code *

Mailing address (if different): *

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Relationship *

Emergency Contact 10 Digit Home Phone Number *

Emergency Contact may pick-up? *

Yes

Emergency contact should have Parent Portal access? *

Yes

Contact #2 First Name *

Contact #2 Last Name *

Contact #2 relationship to student *

Contact #2 10 digit phone number *

Contact #2 may pick up *

Yes

Contact #2 should have Parent Portal Access *

Yes

Contact #3 First Name

Contact #3 Last Name

Contact #3 relationship to student

Contact #3 10 digit phone number

Contact #3 may pick up

Yes

Contact #3 should have Parent Portal access

Yes

Contact #4 First Name

Contact #4 Last Name

Contact #4 relationship to student

Contact #4 10 digit phone number

Contact #4 may pick up

Yes

Contact #4 should have Parent Portal Access

Yes

If paying tuition, District of Residence:

Graduation Year: *

Please list any schools previously attended including location and year(s). *

Please list all children under 21 currently living within the household include grade and date of birth. *

Do you have reason to believe that you/your family is in a "temporary housing situation? *

Yes

Is the student currently under foster care? *

Yes

Does the student have an IEP (Individualized Education Plan) or a 504 plan? *

Yes

Is the student receiving RTI services?

Yes

Are there any subject areas in which the child has had difficulties? If so, which ones? *

Has the student been retained in any grades? If so, which ones? *

Is there anything you think school personnel should know?

Has the student ever received any of the services listed? *

Speech Therapy
Occupational Therapy
Physical Therapy
Evaluations
Psychological Counseling
Skilled Nursing
Special Transportation
None

Does the student have regular dental checkups? *

Yes

Dentist First and Last Name/address

Physician First and Last Name/address *

Is there anything else you think the school nurse should know?

We have 5 different locations for where our UPK Program is offered.

Please rank your location preference using numbers 1-5 for the next 5 questions (1 being first choice, 5 being last choice.)

Maine Memorial, Maine, NY. UPK (FULL DAY) *

Learning Ladder, Endwell, NY. UPK (FULL DAY) *

Northminster Preschool Endwell, NY. UPK (FULL DAY) *

Endwell Preschool Endwell, NY. UPK (FULL DAY) *

Saint Anthony's Endicott, NY UPK (FULL DAY) *Please note that if you are selecting St Anthony's as a location, your child MUST be FULLY potty trained.* *

To complete this process, you will be asked to securely upload the following documents that are needed for registration:

Birth Certificate or Passport

(2) Proofs of Residency forms (mortgage, rental agreement, utility bill)

Proof of Immunizations AND most updated Health Examination

Please attach your students immunization records: *

Add attachment

List of Allowed file types

Please attach the student's most up to date health exam. NYSED requires a physical exam for new entrants and students in Grades Pre-K or K, 1, 3, 5, 7, 9 & 11; annually for interscholastic sports; working papers as needed; or as required by the Committee on Special Education (CSE) or Committee on Pre-School Special education (CPSE). *

Add attachment

List of Allowed file types

Place of Birth:

Please submit your students Birth Certificate.

Place of Birth: Attach Birth Certificate here: *

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List of Allowed file types

Acceptable Proof of Residency

Need (2) forms of acceptable proofs of residency dated within the past 2 months.

MUST HAVE: A copy of residential lease or proof of ownership of a home, such as a deed or a mortgage statement.

AND (1) OF THE FOLLOWING:

Official driver’s license, learners permit or non-driver Identification.

Utility or other bill (NYSEG, Spectrum, or a garbage service).

Voter registration

Car/ renters/ homeowners insurance.

Pay stub

Tax form

Bank statement

Documents issued by federal, state, or local agencies (such as from a local social services agency).

Evidence of custody of the child, including but not limited to judicial custody orders or guardianship papers.

*We cannot accept a copy of an envelope that has been mailed to you. We will need a full copy of the document inside. *

Please attach your 2 forms of proof of residency. *

Add attachment

List of Allowed file types

If there is a custody agreement or foster care paperwork, please attach all documents here:

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List of Allowed file types

Do you give your child permission to be photographed or filmed by members of the media, organizations or agencies at school or district events, for use in publications, websites, social media platforms or video? *

YES, I do give permission for my child to be photographed or filmed by members of the media, organizations or agencies at school or district events—for use in publications, websites, social media platforms or video.

NO, I do not give permission for my child to be photographed or filmed by members of the media, organizations or agencies at school or district events—for use in publications, websites, social media platforms or video.

Todays date: *

Acceptance *
By signing below, I certify that all information provided is accurate and that I have not knowingly or intentionally provided false information in an attempt to mislead or deceive Maine-Endwell Central School District or it's employees responsible for the collection of such information.

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