All of the CPS required forms are conveniently included in the Student Health & School Forms Booklet
Individual Forms are listed below:
Lunch Form (Federal Income Form – SY21/22
We receive funds for each child who qualifies for Free and Reduced Lunch. If we do not have 100% compliance by the 20th day of school we lose funding for the school. You will be contacted on a regular basis until this form has been submitted.
Media Consent Form (Filled out once) English
Breakfast and Lunch are free for all CPS Students
Technology Responsibility Insurance Agreement English
PTA Fee $5.00 individual / $10.00 family
The Chicago Board of Education provides transportation for students in grades K-8, who live more than 1.6 miles and less than 6 miles from school. Parents of children not receiving bussing are responsible for their children’s transportation and punctuality, our school day begins promptly at 7:30 am and ends at 2:30 pm. (PLEASE NOTE: ALL TRANSPORTATION PROVISIONS AND POLICIES ARE SUBJECT TO CHANGE AND THE AVAILABILITY OF TRANSPORTATION MAY BE REDUCED).
Required Physical Examination and Immunization Requirements
Parents are reminded that physical examination and immunization requirements for Chicago public school students are as follows: Students entering kindergarten, sixth, and ninth grade are required to submit proof of physical examination and current immunizations to school by October 15th of each year. Kindergarten Health Requirements, please click here for information.
If you have already submitted a completed Certificate of Child Health Examination Form please accept our appreciation. If you have not met this requirement please submit a completed Certificate of Child Health Examination Form immediately to avoid exclusion. In addition, kindergartners, and any student enrolling for the first time in any grade, are now required to have a full version examination.
Students entering kindergarten, second, and sixth grade must have their dental examination completed by May 15th of each school year. If your child has not received the required examination and your family does not have health care insurance, places contact the Chicago Public School Children and Family Benefit Unit (CFBU). You may be eligible for Allkids or Family Care. Contact CFBU at 773-553-1809.
The following forms allow students to receive their medication under adult supervision at school. With the appropriate forms, students are permitted to carry and self-administer asthma, diabetes, seizure, or allergy medication.
- Physician Request for Self-Administration of Medication [ ENGLISH ]
- Parent Request for Self-Administration of Medication [ ENGLISH | SPANISH ]
- Physician Request for Administration of Medication [ ENGLISH ]
- Parent Request for Administration of Medication to a Student [ ENGLISH | SPANISH ]
- Food Allergy Emergency Action Plan
- Physicians Report on Child with Allergies
- Physicians Request for Student to carry an Epipen
- Asthma Action Plan 5+ Years
- Copy of Parent Request for SELF-Administration of Medication
- Physicians Report on Child with Asthma
- Physicians Request for Student to carry an Inhaler on Person
Minimum Health Requirement forms
All necessary documentation is located below for download.
State of Illinois Child Health Examination form: English
State of Illinois Proof of dental examination form English
State of Illinois vision examination form: English
Physical exam and immunization waivers: English
For more information, contact Coordinated School Health at (773) 553-1830.