YES - Copperas Cove ISD

2016 - 2017 COPPERAS COVE ISD REGISTRATION FORM
Mae Stevens Early Learning Academy
STUDENT INFORMATION
Student Name: _________________________________________________________ Local ID: ____________________ Grade: _________
(LEGAL LAST
FIRST
MIDDLE)
Date of Birth: ________________ Place of Birth: _____________________________
SSN: ______________________ Gender: ________
Student’s Physical Address:_________________________________________________________________________________
Map Zone
Student’s Mailing Address: __________________________________________________________________________________
Student’s Home Phone: ______________________________
MEDICAID #: _______________________________
PARENT / GUARDIAN INFORMATION
Parent / Guardian Name:_______________________________________ Relation:__________________
Cell ph: _____________________
Email: ________________________________________
Wk ph: _____________________
Is the parent / guardian military? YES □ NO □
Employer: _____________________________
Branch: _______________ Rank: _______
Federally Connected? YES □ NO □
Address (if different from Student): _______________________________________________________________________________________
Parent / Guardian Name:_______________________________________ Relation:__________________
Cell ph: _____________________
Email: ________________________________________
Wk ph: _____________________
Is the parent / guardian military? YES □ NO □
Employer: _____________________________
Branch: _______________ Rank: _______
Federally Connected? YES □ NO □
Address (if different from Student): _______________________________________________________________________________________
.
EMERGENCY CONTACT INFORMATION
Name: __________________________________ Relation: _____________________ Cell / Hm ph:________________ Wk ph:______________
Name: __________________________________ Relation: _____________________ Cell / Hm ph:________________ Wk ph:______________
Name: __________________________________ Relation: _____________________ Cell / Hm ph:________________ Wk ph:______________
SIBLING INFORMATION
Name:______________________________________________ Grade: __________ School:________________________________________
Name:______________________________________________ Grade: __________ School:________________________________________
Name:______________________________________________ Grade: __________ School:________________________________________
What school district is your child transferring from? __________________________________________________________________________
Previous Schools attended: ____________________________________________________________Date Entered 9th Grade:________________
Has your child ever been enrolled with Copperas Cove ISD? YES □ NO □
If yes, what year(s): _______________________________
PERSON ENROLLING STUDENT
Person Enrolling Student: ____________________________________________ DOB: ______________ Relation: ____________________
Address if different from student: _______________________________________________
The information above is required for a permanent school record of your child and will be used by school personnel. Presenting false documents, records, or information
is a violation of state law and may subject you to tuition cost for your child. I certify that the information given above is correct. I authorize the school to contact the
person(s) named on this form. In the event parent(s) or other person(s) cannot be contacted, school officials are hereby authorized to take whatever action is necessary in
their judgment for the health of the child named above. I will not hold the school district financially responsible for emergency care and/or transportation.
Parent/Guardian Signature:_________________________________________________
Date:________________________________
For OFFICE use ONLY:
Official Entry Date: ____________________ HR#/Teacher: _____________________ POR: _____ B-Cert: _____ SS Card: ____Photo ID:_____
LANGUAGE PROFICENCY ASSESSMENT COMMITTEE (LPAC)
Copperas Cove
Texas Education Agency Curriculum Division 2014-2015 I 130
Health Record
Retgistro en Salud
Campus Name:_________________________________________ School Year: 2016-2017
Student Name:__________________________________
Grade:________
Gender: _________
Enrollment Date:_____________________
DOB:__________ Student’s Age:_________
Address:__________________________________________________
Home Phone:___________
Parent/Guardian:____________________________ Relation to Student:_______ Work Phone:_________
Parent/Guardian:____________________________ Relation to Student:_______ Work Phone:_________
Should your child have a change in medical condition or status during the school year, it will be your responsibility to
provide updated medical information to the campus nurse. In an effort to provide safe, informed care for your child at
school, CCISD Health Services requires the following information to complete your child's enrollment. Medical
information you provide about your child is a confidential education record. CCISD keeps all medical information about
your child confidential as required by law. However, health information about your child may be communicated to
CCISD school personnel who have a direct "need to know" for the health and safety of your child.
Si su niño(a) tiene un cambio en la condicion medica o de estado durante el ano escolar, sera su responsabilidad de
proporcionar informacion medica actualizada a la enfermera de la escuela. En un esfuerzo por proporcionar una
atencion segura y informada para su niño(a) en la escuela, CCISD Health Services requiere la siguiente informacion
para completar la inscripcion de su niño(a). La informacion medica que proporcione acerca de su niño(a) es un
expediente educativo confidencial. CCISD mantiene toda la informacion medica sobre so niño(a) confidencial
conforme a la ley. Sin embargo, la informacion medica sobre su niño(a) puede ser comunicada al personal escolar
CCISD que tienen una "necesidad de saber" directa para la salud y la seguridad de su niño(a).
Yes
No
Does your child wear glasses?/¿Tiene su niño(a) lentes?
Yes
No
Does your child wear a hearing aid?/¿Tiene su niño(a) audifono?
Yes
No
Is your child eligible for Medicaid?/¿Es su niño(a) elegible para Medicaid?
Medicaid # _________________________________
Medical documentation must be provided for any condition identified below. The necessary forms, to include a
medication permission form, can be accessed at: http://www.ccisd.com/Page/18140. Should your child have any
of the health conditions listed below please complete the appropriate forms and turn in to your child’s campus.
La documentación médica debe ser proporcionada por cualquier condición identificada a continuación. Los formularios
necesarios, que incluyen un formulario de permiso de medicamentos, se puede acceder
en: http://www.ccisd.com/Page/18140. Si su hijo tiene cualquiera de las condiciones de salud que figuran a
continuación por favor complete los formularios correspondientes y entregar a la escuela de su hijo.
Yes
No
Send to Nurse
Does your child have any known health conditions?/¿Su niño(a) tiene alguna condición de salud
conocidos?
CCISDHealthForm/Registration/7-15-16/tm
Yes
No
Does your child have allergies that require medical treatment?/¿Su niño(a) tiene alergias que
requieren tratamiento medico?
If yes, please answer the questions below and provide medical documentation./ Si es así, por favor conteste las
siguientes preguntas y proporcione la documentación médica.
► Food Allergies/Alergias de alimentos:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Do they react to/¿Reaccionan a: ("Yes" all that apply/"Si" a todos los que aplican)
Yes
Yes
Yes
No
No
No
eating it/comerlo?
smelling it/olerlo?
touching it/tocarlo?
► Insect Allergies/Alergias a insectos:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
► Other Allergies/otras alergias:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Yes
No
Does your child require an EpiPen, EpiPen JR, or Twinject Auto Injector for school?/Necesita su
niño(a) un EpiPen, EpiPen JR, o Twinject Auto inyector para la escuela?
IF YES,PLEASE CONTACT THE CAMPUS NURSE! Additional paperwork must be completed. A doctor’s note
stating what food the child is allergic to and what type of allergy the child has (ingestion, contact, inhalation) is
required.
SI ES NECESSÁRIO, POR FAVOR PÓNGASE EN CONTACTO CON LA ENFERMERA DE LA ESCUELA!
Documentacion adicional debe ser completada y una nota del medico que indique que tipo de alimentos que el
niño(a) es alergico y que tipo de alergia tiene el nino(a) (ingestion, contacto, inhalacion).
Medical documentation must be provided for any condition identified below./La documentación médica debe ser
proporcionada por cualquier condición identificada a continuación.
Yes
No
Yes
No
Does your child have Diabetes?/¿Tiene su niño(a) diabetes?
⇒ Describe Diabetes Type/Describa el tipo de diabetes: ________________________________
Does your child have Asthma?/¿Tiene su niño(a) asma?
⇒ Asthma meds, please list/Lista de Medicamentos para el asma________________________
____________________________________________________________________________
Yes
No
⇒ Does your child use a nebulizer?/¿Tiene su niño(a) un nebulizador?
_____________________________________________________________________________
Does your child have a Heart Condition, such as (heart defect, high blood pressure, irregular
heart beats, etc)?/¿Tiene su niño(a) una enfermedad del Corazon, tales como (defecto del
corazon, presion arterial alta, latidos irregulares del corazon, etc)?
⇒ List Heart Condition./Enumere las condiciones de corazon :
__________________________________________________________________________
Send to Nurse
CCISDHealthForm/Registration/7-15-16/tm
Yes
No
Does your child have ADD (Attention Deficit Disorder), ADHD (Attention Deficit Hyperactivity
Disorder)?/¿Tiene su niño(a) ADD (Desorden de Deficit de Atencion), ADHD (Deficit de Atencion e
Hiperactividad).
Yes
No
Does your child have Seizures?/¿Tiene su niño(a) convulsiones?
Yes
No
Any/all other health conditions to include, nerve, muscle, or bone disorders, migraines, cerebral
palsy, respiratory conditions, and any visual impairments such as blindness, prosthesis, eye surgies
(specify which eye is involved), and any other health condition not listed in any of the other
categories./Por favor escriba cualquier / todos los otros problemas de salud que incluyen,
enfermedad de los nervios, musculos o huesos, migranas, paralisis cerebral, infecciones
respiratorias y las deficiencias visuales como la ceguera, protesis, cirugia oculares (especificar el
ojo involucrado), y otra condicion de salud no incluidas en ninguna de estas categorias.
⇒ Please list any other health conditions./Por favor escriba cualquier otras condiciones de salud:
________________________________________________________________________________________
________________________________________________________________________________________
►Please contact the campus nurse if your child requires a special procedure (e.g., catheterization, tube feeding, glucose
monitoring, nebulizer, etc.) as a separate permission form is required.
Por favor, póngase en contacto con la enfermera de la escuela si su niño(a) requiere un procedimiento especial
(por ejemplo, el cateterismo, la alimentacion por sonda, monitoreo de la glucosa, nebulizador, etc) ya que se
requiere un formulario de permiso separada.
►Please list any dietary needs or restrictions. The Campus must have written physician order stating reason for
restriction./Se requiere autorización porescrito del medico con la razon de la restricciones
dieteicas_______________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Yes
No
Will your child receive medications during the school day? If so, please list the name, dosage,
and reason below./¿Va recibir su niño(a) medicamentos durante el día escolar? Si es así, por
favor indique el nombre, la dosis, y la razón a continuación.
Medication Name
Nombre del medicamento
Dosage
Dosis
Reason taken
Razón tomado
Important: Any medication needed at school must be brought to the campus nurse in the original prescription or over
the counter bottle. All prescription medication must have written physician approval (valid prescription) before receiving
at school. Parents must complete paperwork before any medication will be given at school./Cualquier medicacion
necesaria en la escuela debe ser llevado a la enfermera de la escuela en el empaque original. Todo medicamento
prescribido, require la receta del medico para ser aceptada por la escuela. Se require que las formas esten
completadas por los padres antes de que la enfermera administre cualquier medicamento.
Send to Nurse
CCISDHealthForm/Registration/7-15-16/tm
**Medical documentation must be provided for any condition identified above. The necessary forms, to include a
medication permission form, can be accessed at: http://www.ccisd.com/Page/18140 Should your child have any
of the health conditions listed above please complete the appropriate forms and turn in to your child’s campus.
**La documentación médica debe ser proporcionada por cualquier condición identificada anteriormente. Los formularios
necesarios, que incluyen un formulario de permiso de medicamentos, se puede acceder
en: http://www.ccisd.com/Page/18140. Si su hijo tiene cualquiera de las condiciones de salud anteriormente mencionadas
por favor complete los formularios correspondientes y entregar a la escuela de su hijo.
► In the event of a serious medical event, accident or illness, the school nurse or
campus administrator will notify parent(s)/emergency contacts. In the event that there is
no contact made with the numbers listed for the student and the student's condition
should deteriorate and/or become an emergency, 911 will be notified and neither the
district, school and/or employees shall be held financially responsible.
► En el caso de un problema medico grave, accidente o enfermedad, la enfermera o
administrador notificara al padre(s)/contactos de emergencia. En el caso de que no se
pudo contactar con los numeros que se indican para el estudiante y la condicion del
estudiante podria deteriorarse y/o convertirse en una emergencia, 911 sera notificado
y ni el distrito escolar y/o empleados podrian ser responsables financieramente.
Yes
No
If in the judgment of any representatives of the school, the above
student needs immediate care and treatment as a result of any injury
or sickness, I do hereby request, authorize, and consent to such care
and treatment as may be given to said student by any physician,
licensed athletic trainer, nurse, hospital, or school representative; and
I do hereby agree to indemnify and save harmless the school and any
school representative from any claim by any person whomsoever on
account of such care and treatment of said student.
Si, a juicio de algún representante de la escuela, el estudiante mencionado
anteriormente necesita de la atención y el tratamiento inmediato como resultado
de una lesión o enfermedad, solicito, autorizo y doy consentimiento a la atención
y tratamiento de dicho estudiante por cualquier médico, entrenador deportivo,
enfermera o representante escolar. Acepto por la presente mantener indemne y
eximir de responsabilidad a la escuela y a cualquier representante de la escuela
contra cualquier reclamación hecha por cualquier persona por motivo de la
mencionada atención y tratamiento de dicho estudiante.
Preferred Hospital/ Hospital Preferido:_____________________________________
Signature/Firma:______________________________Date/fecha:____________________
Send to Nurse
CCISDHealthForm/Registration/7-15-16/tm
Texas Public School Student/Staff Ethnicity and Race Data Questionnaire
Texas Education Agency
The United States Department of Education (USDE) requires all state and local education institutions to
collect data on ethnicity and race for students and staff. This information is used for state and federal
accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal
Employment Opportunity Commission (EEOC).
School district staff and parents or guardians of students enrolling in school are requested to provide this
information. If you decline to provide this information, please be aware that the USDE requires school
districts to use observer identification as a last resort for collecting the data for federal reporting.
Please answer both parts of the following questions on the student’s or staff member’s ethnicity and race.
United States Federal Register (71 FR 44866)
Part 1. Ethnicity: Is the person Hispanic/Latino? (Choose only one)
Hispanic/Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other
Spanish culture or origin, regardless of race.
Not Hispanic/Latino
Part 2. Race: What is the person’s race? (Choose one or more)
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.
Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the
Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan,
the Philippine Islands, Thailand, and Vietnam.
Black or African American - A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of
Hawaii, Guam, Samoa, or other Pacific Islands.
White - A person having origins in any of the original peoples of Europe, the Middle East, or North
Africa.
________________________________
Student/Staff Name (please print)
________________________________
(Parent/Guardian)/(Staff) Signature
________________________________
________________________________
Date
Student/Staff Identification Number
This space reserved for Local school observer – upon completion and entering data in student software
system, file this form in student’s permanent folder.
Ethnicity – choose only one:
Race – choose one or more:
_____ American Indian or Alaska Native
_____ Hispanic / Latino
_____ Asian
_____ Black or African American
_____ Not Hispanic/Latino
_____ Native Hawaiian or Other Pacific Islander
_____ White
Observer signature:
Texas Education Agency – March 2010
Campus and Date:
Military/Foster Status
Dear Parent or Guardian:
It is a state mandate that all school districts collect data on the following: Military Connected Students
(HB525) and Foster Care Status (SB833) Please select Yes or No for each of the following statements, using the
drop down box provided.
Thank you in advance for your cooperation.
Section 1: Military Connected Students:
Yes
No
My child is a (Kinder – 12th grade) dependent of a member of the Army, Navy,
Air Force, Marine Corps, or Coast Guard on ACTIVE DUTY
Yes
No
My child is a (Kinder – 12th grade) dependent of a member of the Texas National
Guard (Army, Air Guard, or State Guard)
Yes
No
My child is a (Kinder – 12th grade) dependent of a member of a Reserve Force in
the United States military (Army, Navy, Air Force, Marine Corps, or Coast
Guard)
Yes
No
My child is a Pre-Kindergarten student who is a dependent of an active duty
uniformed member of the Army, Navy, Air Force, Marine Corps, or Coast Guard,
or activated/mobilized uniformed member of the Texas National Guard (Army,
Air Guard, or State Guard) or who was injured or killed while serving on active
duty.
Section 2: Foster Care Status:
Yes
No
My child is currently in the conservatorship of the Department of Family and
Protective Services.
Yes
No
My child is a Pre-Kindergarten student who was previously in the conservatorship
of the Department of Family and Protective Services following an adversary
hearing held as provided by Section 262.201, Family Code.
If you marked “Yes” to either question in Section 2, please provide your child’s campus with a copy of
the Texas DFPS Placement Authorization Form (Form 2085)
Student Name: ____________________________________
Campus: ________________________
Printed Parent Name: _______________________________
Parent Signature: __________________________________
Date:_______________________
Copperas Cove ISD
Family Survey
2016-2017
In order to better serve your child/children, the school district would like to identify students who may qualify
to receive additional educational services. The information provided will be kept confidential.
Please print and return form to school office:
Campus: __________________________________
Date: _________________
Student Name: _____________________________
Grade: ________
Father/Guardian: ___________________________
Mother/Guardian: __________________________
Father’s Place of Employment: ________________
Mother’s Place of Employment: _______________
Home Address: _____________________________
City: ____________________Zip: ______________
Home Phone: ______________________Cell Phone: _____________________Work Phone: ______________
Please answer the following questions:
1. Within the past 3 years have you moved from one city, state, or school district to another?
☐ Yes
☐ No
2. If yes, did you or your child move/leave in order to work (temporary or seasonal) in agriculture or fishing?
(By checking yes, you are stating that you have worked in agricultural or fishing work within the last 36 months).
☐ Yes
☐ No
If you answered YES to question 2, please check all that apply.
Working with
fruits, vegetables,
cotton, wheat,
grain, agricultural
farms, fields or
vineyards
Working in
a cannery
☐
Working on a dairy farm.
Working on a ranchfeeding livestock, clearing
fields, building fences
☐
☐
Working in a slaughter
House-packaging and
cutting meat
☐
Working in a plant,
nursery or
orchard, growing
or harvesting trees
or picking pecans
☐
Other similar work, please explain:
__________________________________
Working in a
fishery
☐
Working on a
poultry farm
__________________________________
☐
For more information, please contact Migrant Service Coordinator: _____________________________________
SCHOOL DISTRICT PERSONNEL: THIS FORM CAN NOT BE ALTERED
11-15/FP
Copperas Cove ISD Parent/Student Acknowledgement
Copperas Cove ISD Padre/Estudiante Reconocimiento
2016-2017
Campus: _____________________________________________
Student Name:_________________________________________
Grade:________
Parent Name: _________________________________________
•
Student Code of Conduct/Student Handbook / Codigo de Conducta/Manual del Estudiante
The Student Code of Conduct and Student Handbook may be accessed by going to www.ccisd.com
El Codigo de Conducta y el Manual del Estudiante se pueden accesar en www.ccisd.com
•
Student Responsible Use Policy (RUP)/Estudiante Politica de Uso Responsible (PUR)
Student Responsible Use Policy for the District Electronic Communication System may be accessed by going
to www.ccisd.com and can be found in the Student Handbook. La Politica de Uso Responsable del Estudiante
del Sistema de Comunicacion Electronico del Distrito se puede accesar en www.ccisd.com y se puede encontrar
en el Manual del Estudiante.
•
Requesting a hard copy of the above policies/Para solicitar una copia impresa del las politicas
anteriores
A hard copy of the Student Code of Conduct, Student Handbook, or Student Responsible Use Policy for the
District Electronic Communication System is available upon request at your student’s campus any time during
the school year. Una copia del Código de Conducta del Estudiante, Manual del Estudiante y Politica de Uso
Responsable del Estudiante del Sistema de Comunicacion Electronico del Distrito está disponible bajo petición en
la escuela de su estudiante en cualquier momento durante el año escolar.
Parent Acknowledgment:
My child and I have received notice of access to the Copperas Cove ISD Student Code of Conduct, Student Handbook, and
Student Responsible Use Policy for the District Electronic Communication System for the 2016-2017 school year. We
acknowledge that we are responsible for reading and understanding the rules, expectations, and important information
contained in the Student Code of Conduct, Student Handbook, and Student Responsible Use for the District Electronic
Communication System. All students will be held accountable for their behavior and will be subject to the disciplinary
consequences outlined in the above mentioned documents. If I have any questions regarding the Student Handbook or
Code of Conduct, I should contact the campus principal.
Reconocimiento de los Padres:
Mi niñó(a) y yo hemos recibido notificacion de acceso al Código de Conducta del Estudiante de Copperas Cove ISD, Manual
del Estudiante, y Politica de Uso Responsable del Estudiante del Sistema de Comunicacion Electronico del Distrito para el año
escolar 2016-2017. Reconocemos que somos los responsables de la lectura y la compression de las reglas, las espectativas y
información importante contenida en el Código de Conducta del Estudiante, Maunal del Estudiante, y La Politica de Uso
Responsable del Estudiante del Sistema de Comunicacion Electronico del Distrito. Todos los estudiantes seran responsables
por su comportamiento y estarán sujetos a las consecuencias disciplinarias descritas en los documentos antes mencionados.
Si tiene alguna duda sober el Manual del Estudiante o el Código de Conducta, debe contactar al director de la escuela.
Signature/Firma:______________________________________Date/Fecha:____________________
Parent-Student Acknowledgement/Student Services/5-3-2016/tm
Copperas Cove ISD Directory Information
Copperas Cove Información de Directorio
2016-2017
Campus Name: ________________________________________
Student Name:_________________________________________
Grade:________
Parent Name: __________________________________________
Directory Information/Releases/Información de Directorio/Comunicados
Certain information about District students is considered directory information and will
be released to anyone who follows the procedures for requesting the information,
unless the parent or guardian objects to the release of the directory information about
this student. If you do not want Copperas Cove ISD to disclose directory information
from your child's education records without your prior written consent, you must notify
the District in writing within ten school days of the child's first day of instruction for this
school year.
Cierta información acerca de los estudiantes del distrito se considera la información del
directorio y será revelado a cualquier persona que sigua los procedimientos para solicitar la
información, a menos que el padre o tutor se oponga a la liberación de datos del directorio
sobre este estudiante. Si usted no desea que Copperas Cove ISD revele la información del
directorio de los registros de Educación de su hijo(a) sin su previo consentimiento, deberá
notificar por escrito, dentro de diez días escolares del primer día de clases de su hijo(a) para
este año escolar.
This means that the district must give certain personal information (called “directory information”)
about your child to any person who requests it, unless you have told the district in writing not to do so.
In addition, you have the right to tell the district that it may, or may not, use certain personal
information about your child for specific school-sponsored purposes. This document with your signature
will fulfill the written consent requirement. Directory information for District students has been classified into
two separate categories:
Esto significa que el distrito debe dar cierta información personal (llamada " información de directorio" ) acerca de su
hijo(a) a cualquier persona que lo solicite , a menos que usted haya dado al distrito instrucción por escrito al
contrario. Además, usted tiene el derecho de decirle al distrito que puede, o no puede, usar cierta información
personal acerca de su hijo(a) para eventos escolares especificos patrocinados por la escuela. Este documento con su
firma cumplirá el requisito de consentimiento por escrito.
Información del directorio para los estudiantes del distrito se ha clasificado en dos categorías distintas:
Directory Information/Student Services/5-3-2016/tm
Category I - School/District Purposes/Categoría I - Distrito Escolar/propósitos:
For the following school sponsored purposes: yearbook, school newspapers: honor roll;
school, athletic, and graduation programs; service providers that contract with the District
for school-sponsored purposes; other District publications and announcements; District
use of social media; and information distributed to the media related to school events or
placed on the District’s website-Copperas Cove ISD has designated the following
information as directory information:
Para los sigu ient es eventos pat rocinados con el propósito escolar: el anuario, el
periodico de la escuela, el honor roll, eventos atleticos, escolares y programas de
graduacion; proveedores que tienen contrato con el Distrito para eventos escolares; otras
publicaciones y anuncios del Distrito, el uso de los medios sociales y la informacion
distribuida a la media relacionada con los eventos escolares or colocado en el sitio del web
del Distrito. Copperas Cove ISD ha designado la siguiente información como información del
directorio:
student's name/nombre del estudiante
photograph/fotografía
date of birth/fecha de nacimiento
major field of study/campo principal de estudio
honors and awards/reconocimientos y premios recibidos
dates of attendance/fechas de asistencia
grade level/nivel de grado
enrollment status/estado de inscripción
participation in officially recognized activities and sports/participación en
deportes y actividades oficialmente reconocidas
• weight and height of members of athletic teams/peso y estatura de miembros de
equipos atléticos
• student identification numbers or identifiers that cannot be used alone to gain
access to electronic records/números de identificación del estudiante o
identificadores que no se puede utilizar solo para obtener acceso a archivos
electrónicos educativos
•
•
•
•
•
•
•
•
•
Per Board Policy FL(LOCAL): A parent shall not be permitted to object to the release of individual items from the
directory information list established by the District.
Política FL (LOCAL ) : Un padre no se le permitirá objetar la liberación de los elementos individuales de la lista de
información del directorio establecida por el Distrito
SCHOOL DISTRICT USE/USO DEL DISTRITO ESCOLAR :
Yes___ No___ I give the district permission to use the information in the above list for school/district sponsored
activities./ Doy permiso al distrito de 2tilizer la información de la lista anterior para actividades escolares
patrocinadas por la escuela/distrito.
Directory Information/Student Services/5-3-2016/tm
Category II – All Other Purposes (Public)/ Categoría II – Todos los otros propósitos
(Públicos):
For all other purposes/ Copperas Cove ISD has designated the following information as directory
information: Consentimiento para todos los otros propósitos:
•
•
•
student’s name/nombre del estudiante
student address/ dirección del estudiante
grade level/nivel de grado
PUBLIC USE/USO PÚBLICO:
Yes___ No___ I give the district permission to use the information in the above list for all other
purposes./ Doy permiso al distrito de 3tilizer la información en la lista anterior para todos los otros
propósitos.
Category III – High School Only/Categoría III – Secundaria Solamente
MILITARY RECRUITERS/LOS RECLUTADORES MILITARES:
Yes___ No___ I give the district permission to provide Military Recruiters with the following information:
student’s name, address, and telephone listing./autorizo al distrito proveer a los reclutadores militares con la
siguiente información: nombre, dirección y listado de teléfono del estudiante.
HIGHER EDUCATION/EDUCACIÓN SUPERIOR:
Yes___ No___ I give the district permission to provide Institutions of Higher Education with the following
information: student’s name, address, and telephone listing./autorizo al distrito proveer a las instituciones de
educación superior con la siguiente información: nombre, dirección y listado de teléfono del estudiante.
OTHER: Use of Student Work in District Publications/Uso de Trabajo del Estudiante en
Publicaciones del Distrito
Occasionally, the Copperas Cove ISD wishes to display or publish student artwork or special projects on the district’s Web site
and in district publications. The district agrees to only use the student projects in this manner.
En ocasiones, Copperas Cove ISD desea exhibir o publicar el arte o proyectos especiales del estudiante en el sitio Web del
distrito y en publicaciones del distrito . El distrito se compromete a 3tilizer únicamente los proyectos de los estudiantes de
esta manera.
USE OF STUDENT WORK IN DISTRICT PUBLICATIONS:/USO DE TRABAJO DEL ESTUDIANTE EN
PUBLICACIONES DEL DISTRITO:
Yes___ No___ I give the district permission to use my child’s artwork or special project on the district’s
website and in district publications.
Doy permiso al distrito de usar el arte o proyecto especial de mi hijo(a) en el sitio web del distrito y en
publicaciones del distrito.
Parent Signature/Firma: _____________________Date/Fecha: ______________
Directory Information/Student Services/5-3-2016/tm
REQUEST FOR RECORDS
Date: _____________________
Last school attended: ___________________________________________________________________
Address: _____________________________________________________________________________
City & State: __________________________________________________________________________
The following student has enrolled at _________________________________. He/she has indicated
last attendance in your school/District. Please send the following:







Cumulative Record/Academic Record
Discipline Record
Attendance
Numerical grades – if grades are not numerical, please send a grade scale/key.
Health Records/Shot Records
Withdrawal Grades
Please indicate whether or not we need to request special education records and provide an
address or phone number where we may request them.
Student Name
Grade
___________________________________________________
______________
___________________________________________________
______________
___________________________________________________
______________
I have given permission for all records of the above child(ren) to be released to the Copperas Cove
Independent School District.
________________________________________________________________
Parent/Guardian Signature
Please send records to: _____________________________________________________
_____________________________________________________
_____________________________________________________
Please note that the Buckley Amendment (dated June 17, 1976) no longer makes it necessary to have a parent’s Signature when records are being requested from one educational institution to another educational institution.
Copperas Cove ISD does not discriminate against any person because of race, color, religion, sex, national origin, disability, age, or on any other basis prohibited by
law. Copperas Cove ISD no discrimina a ninguna persona debido a la raza, el color, la religión, las relaciones sexuales, el origen nacional, la incapacidad, la edad, o
sobre cualquier otra base prohibida por ley.
Request for Records/6-10-2015/Curriculum Office/TM