Forms

Many forms are fillable using Free Adobe Acrobat.
For help with forms, email [email protected]

Student Enrollment, Withdrawal, and Residency Forms

Initial Registration Form	PS-001
Notice of Intent: Instruction of Student at Home	PS-036
Release of Information	PS-003
Release of Information (Spanish)	PS-003S
Residency Verification and Affidavits	PS-019
Residency Verification Affidavit RENEWAL only	PS-019A
- Homeless Children & Youth: Student Residency Affidavit (Parent/Guardian Form)	PS-059A
- Homeless Children & Youth: Affidavit for Missing Documentation (Parent/Guardian Form)	PS-059A-1
- Homeless Children & Youth: Student Residency Affidavit (Unaccompanied Youth Form)	PS-059B
- Homeless Children & Youth: Affidavit for Missing Documentation (Unaccompanied Youth Form)	PS-059B-1
Withdrawal Form (Eliot & Joel)	PS-007A
Withdrawal Form (Morgan)	PS-007B
(Acknowledgement of) Withdrawal of 17-year old from School	PS-030

Student Health Forms

Authorization for Administering Medicine	H-005
Early Childhood Health Assessment Record (State of Connecticut)	ED161
Field Trip Medical Emergency Form	H-008
Health Assessment Record (State of Connecticut)	HAR-3
Homebound Hospitalization Instruction	PS-033
Medical Exemption Certification Statement (CDPH)	State of CT
Refusal to Permit Administration of Epinephrine for Emergency First Aid	PS-060
Refusal to Permit Administration of Opioid Antagonists for Emergency First Aid	PS-064
Release of Health Information	H-033
Written Authorization for the Possession and Application of Sunscreen in School	PS-061
Yearly Health Report (New Students Only)	H-003

Permission/Denial Forms

Denial of Permission to Release Directory Information	PS-010
Emergency Early Dismissal Information Form (Joel)	PS-004
Handbook-Photo-Media Access Acknowledgement (Eliot)	PS-009A
Permission to Publish Student Work/Photograph Electronically	PS-009
Notice of Parent Rights	PS-040

Safe Schools Forms

Parent-Staff Report of Suspected Bullying Behaviors	PS-027A-3
Student Report of Suspected Bullying Behaviors	PS-027A-1

Discrimination & Harassment Forms (Students/Community)

Discrimination/Harassment Complaint Form (STUDENTS) Regulation 5152	PS-057
Discrimination/Harassment Complaint Form (COMMUNITY) Regulation 1400	PS-062
Sexual Harassment Under Title IX Complaint Form (STUDENTS) Regulation 5151	PS-053
Sex Discrimination (other than sexual harassment under Title IX) (STUDENTS) Regulation 5151	PS-054

Miscellaneous Forms

Request for Review of Educational Material

PS-043

Clinton Public Schools