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Physical and Dental Forms

In compliance with State-mandated physical examination/ immunization requirements all students entering Early Childhood, Kindergarten, sixth and ninth grades must have a physical examination by a doctor.

To ensure adequate protection and a positive start to the new school year for all of our students, the nursing staff asks that ALL required physical examinations/ immunizations be submitted to the District or your child's school as soon as possible. (Please make a photocopy of all submitted exam forms to keep for your own records.)  At the high school level, forms may be mailed to York High School Health Services, 355 W. St. Charles Road, Elmhurst, IL 60126

The Certificate of Child Health Examination, Proof of Dental Examination and Proof of Vision Exam may be picked up at your child's school office, the District 205 Center, 162 S. York Street, or downloaded below. Questions may be directed to your child’s school office/health office.

Due to the high demand for medical appointments with local physicians, it is recommended that you schedule appointments as soon as possible.

Following are the immunization/medical examination guidelines required by school policy and State law:

  1. All health examinations must be dated within one year before entering Madison Early Childhood Education Center, Kindergarten, sixth and ninth grades.
  2. All health examinations must be dated within one year of entering school when a student transfers from another Illinois school district and is entering Kindergarten, sixth or ninth grade.
  3. Health examinations are required whenever an out-of-state student first enrolls in a District 205 school, regardless of the student’s grade.

Failure to comply with the above requirements by October 15 can result in the student’s exclusion from school until the required completed health forms are presented to the District.

Vision Exam

In addition to the physical examination and immunization requirements, the Illinois State Board of Education requires proof of a vision exam for all Kindergarten students, as well as for any new student entering the District for the first time. Vision exams must be documented on the Illinois Department of Public Health vision form. Parent(s)/guardian(s) must present proof of their child/children having been examined by an ophthalmologist or an optometrist before October 15 of the current school year for students entering Kindergarten and new students to the school district.

Vision Exam Form

Dental Exam

Dental exams are also required for students entering Kindergarten, second and sixth grades. Dental exams must be documented on the Illinois Department of Public Health dental form. Parent(s)/guardian(s) must present proof of their child/children having been examined by a licensed dentist before May 15 of the current school year.

Dental Examination Form

Formulario Comprobante Del Examen Dental Escolar

Health Exam and Sports Physical Forms

All middle and high school students who plan to participate in sports are reminded that physical examinations must cover them throughout the entire sport season. Sports physicals are required every year since they are effective for twelve months only. These students should schedule appointments accordingly.

Health Examination & Sports Physical Form

Certificado De Examen De Salud Del Niño(a)


All students who are required to take medication (over-the-counter or prescription) during school hours (including inhalers, Epi-Pens, and insulin) must have a completed Medication Authorization Form on file, which is signed by the doctor and Parent/Guardian. The Medication Authorization Form must be completed annually or whenever there is a change in medication and/or dosage.

Medication Authorization Form


Administración de Medicinas por Personal del Distrito en la Escuela


The Illinois State Board of Education requires the school district to notify parents of the medication policy within 15 days of enrollment.

 Medication Policy

Other Forms

New Student Information Form must be filled out for new students entering the district to begin the registration process. English | Spanish

Special Residency Affidavit - If the student resides in a property owned or leased by someone other than their parent or guardian, a notarized residency affidavit must be signed by the owner of the lease or property. English | Spanish

Release of Records (Early Childhood/ Elementary/ Middle School)
Student Record Exchange (York)


Home Language Survey

Home Language Survey (English)
Encuesta sobre idioma materno (Spanish)
استطلاع اللغة في المنزل  (Arabic)
വീട്ടിലെ ഭാഷയെ കുറിച്ചുള്ള സർവേ  (Malayalam)
Ankieta dotycząca języka używanego w domu (Polish)
Survey sa Wika sa Tahanan (Tagalog)


Contact Information:

Elmhurst CUSD 205
162 S. York
Elmhurst, Illinois 60126

Ph: (630) 834-4530
Fax: (630) 617-2345

York deferred payment

Form should be completed and returned with the pre-pack form or on book sale dates.

Deferred Payment Form - English (YORK)
Deferred Payment Form - Spanish (YORK)

2018-19 Financial Assistance

The application for fee waiver will not affect the process that is currently in place for students qualifying for free or reduced meals through the National School Lunch Program. You will still need to complete a separate application for free or reduced meals through the National School Lunch Program. The fee waiver application and instructions are available below.

Applications for the 2018-19 school year will be accepted starting July 1, 2018 (applications received before this date will be returned). 

Financial Assistance waiver Application (2018-19) 

DEADLINE - Request For Financial Assistance - Waiver of Student Fees are due by Thursday, November 15, 2018.

National School Lunch Program Application 


Elementary & Middle School

High School


Completed free/reduced lunch applications must be turned in to your child's school for initial authorization.

Free and Reduced Lunch – Families that meet the federal guidelines are entitled to free or reduced lunch. To receive assistance, the Free and Reduced Lunch form must be completed and returned to the District Office. The form can not be completed prior to July 17th, and must include financial information for July on the District 205 registration website or in the York Principals’ Office.

Families that receive the Direct Certification and Categorically eligibile letter during the week of July 20th stating their child is free will not need to fill out the free application.  They should receive a letter for each child in their family and if they do not please call Food Services so we can make sure all family members are included.  Please keep this letter as you may need for other programs and benefits (Comcast, Park District etc)