Items Required for Enrolling New Students in CCISD Copperas
Transcripción
Items Required for Enrolling New Students in CCISD Copperas
Items Required for Enrolling New Students in CCISD Copperas Cove ISD Registration 2014-2015 Student’s Social Security card Official birth certificate Current immunization records Proof of residence within CCISD (current utility bill or lease contract) Emergency contact information Copy of student’s records from school most recently attended (if applicable) Guardianship papers (if applicable) 2014 – 2015 COPPERAS COVE ISD REGISTRATION FORM CAMPUS: __________________________________________ STUDENT INFORMATION Student Name: _________________________________________________________ Local ID: ____________________ Grade: _________ (LEGAL LAST FIRST MIDDLE) Date of Birth: ________________ Place of Birth: _____________________________ SSN: ______________________ Gender: ________ Student’s Physical Address:_________________________________________________________________________________ Student’s Mailing Address: __________________________________________________________________________________ Student’s Home Phone: ______________________________ Map Zone 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): _______________________________ BUS INFORMATION Will your child be using bus transportation to get to school? YES □ NO □ If yes, bus route/number:___________________________ 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:_________________________________ Person Enrolling Student: ____________________________________________ DOB: ______________ Relation: ____________________ For OFFICE use ONLY: Official Entry Date: ____________________ HR#/Teacher: _____________________ Proof of Residence: _____ B-Cert: _____ SS Card: ____ Copperas Cove High School 400 S. 25th St Copperas Cove, TX 76522 Tel: (254) 547-2534 Fax: (254) 547 -2671 RECORDS REQUEST Student Name____________________________________________Date of Birth_______________ Grade___________________ Year entered 9th grade____________________ Previous School Address Tel. Number______________________ Fax Number___________________________ ______________________________________ ______________________________________ ______________________________________ For counselor or registrar: please check any that apply and return to Nicole: Fax (254) 547-2671 Please fill out the 3 boxes below Has this student been assigned to a Alternative School due to Discipline? No________ Yes_______ Owes # of Days______ Did the student at any time receive Special Education services? Yes_______No________ Is the student a member of NHS? If yes, please specify and send record of Does the student qualify for 504? such action. Yes________No_______ Did the student receive Gifted Education services? Yes_______No________ Yes________No_______ Please send us the following information as soon as possible: Fax and mail official transcript, withdrawal form & withdrawal grades Health/Shot records Standardized test results (in Texas: TAKS) An interpretation of your marking system Birth Certificate/Social Security Card Gifted and Talented packet 504 Packet/ Special Education records Minimum Graduation Plan (if applicable) Discipline and attendance records Report cards and/or Progress reports Other:_____________________________________________________________________________ The Federal Family Educational Rights and Privacy Act of 1974, Section 1232g, Family Educational Privacy Rights, and the Texas Attorney General Open Records Decision Number 152., Obligation to Make Available Copies of Student Education Records, January 28, 1977, mandate that students and their parents have an undeniable right to the Academic Achievement Record. It is illegal to withhold the transcript because the student or the family owes money to the school or for any reason. ______________________________________________________ Date:_____________________________ Parent/Guardian Signature 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 Your prompt attention to this matter will be greatly appreciated. Respectfully, Nicole Barker Registrar’s Secretary 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 a box in each section below. Please complete this form and return to your student’s campus. Thank you in advance for your cooperation. Section 1: Military Connected Students: My child is NOT a military connected student My child is a dependent of a member of the Army, Navy, Air Force, Marine Corps, or Coast Guard on Active Duty My child is a dependent of a member of the Texas National Guard (Army, Air Guard, or State Guard) My child is a dependent of a member of a reserve force in the United States military (Army, Navy, Air Force, Marine Corps, or Coast Guard) 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) who was injured or killed while serving on active duty. Section 2: Foster Care Status: My child is NOT currently in the conservatorship of the Department of Family and Protective Services. My child is currently in the conservatorship of the Department of Family and Protective Services 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. Student Name: _________________________________ Date: ________________________ Printed Parent Name: _____________________________ Parent Signature: __________________________ COPPERAS COVE INDEPENDENT SCHOOL DISTRICT Student Residency Questionnaire Title 1, Part A- McKinney-Vento Program This questionnaire is intended to address the requirements of the McKinney-Vento Act of 2001 concerning children and unaccompanied youth who find themselves in situations identified as homeless. Your answers will help the district’s liaison ensure protection of educational rights and to determine the services to be provided with federal, state, and local funds to those students who qualify for services. Part A School student is being enrolled in:__________________________________________________________________ Student is being enrolled by: ______ Parent ______ Guardian ______ Self Name of Student: _______________________________________________________________________________ Last First Birth Date ____/____/_______ Age: _______ Grade: _______ Middle Male ______ Female_____ Month/ Day / Year School Aged Siblings:____________________________________________________________________________________ (Please provide first and last names) Name of Parent(s)/Guardians_________________________________________________ Phone___________________ Address_______________________________________________________________________________Zip__________ Signature of Parent/Guardian _____________________________________________________Date________________ Part B 1. Is your current address a temporary living arrangement? _____Yes _____No 2. Is this temporary living arrangement due to loss of housing or economic hardship? _____Yes _____No (military transitions do not constitute a loss of housing or economic hardship) If you answered YES to both of the questions above, please complete Part C below. Part C Where is the student presently living? (Check one) _____ In a motel/hotel _____ In a shelter Name and location of shelter ______________________________________________ _____ With more than one family in a house or apartment _____ Moving from place to place _____ In a place not designed for ordinary sleeping accommodations such as a car, park, or campsite Presenting a false record or falsifying records is an offense under Section 37.10, Penal Code, and enrollment of the child under false documents subjects the person to liability for tuition or other costs. TEC Sec. 25.002(3)(d). STUDENT ID (provided by campus) _________________ Part D – For Campus/District Use Only If the answers in Part B are both marked “Yes,” please fax this questionnaire to Shelley Brown at the Central Office. FAX: 254-547-4923 Homeless _____ Not Homeless ______ Date ______________ Per _______________________________________ PEIMS Code: 1 2 3 4 Unaccompanied Youth ____Yes ____No (Code 2 if marked Yes) Received by PEIMS Secretary ____________________________ Date/initials Entered ___________________________ Date/Initials Verified__________________________________ Date/initials 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 discriminan en base de la raza, del color, de la religión, del sexo, del origen nacional, disabilidad, de la edad, o empleo como lo requiere la ley. www.ccisd.com/ Facebook@Copperas Cove ISD/ Twitter @copperascoveisd Student Residency Questionnaire/11.22.13/Central Administration/SB COPPERAS COVE INDEPENDENT SCHOOL DISTRICT Residencia Estudiantil Cuestionario Title 1, Part A- McKinney-Vento Program Este cuestionario se destina a atender a las necesidades de la McKinney-Vento Act de 2001 relativa a los niños y jóvenes no acompañados que se encuentran en situaciones identificadas como hogar. Sus respuestas ayudará a que el distrito s enlace para garantizar la protección de derechos al educación y a determinar los servicios que se proporcionó federal, estatal y local fondos a aquellos estudiantes que califican de servicios. Parte A Estudiante de la Escuela está matriculado en_____________________________________________________________ El estudiante está siendo matriculado por: _______Padre _______Tutor legal _______Identidad Nombre del Estudiante_____________________________________________________________________ Fecha de nacimiento____/____/_______ Edad: _______ Grado: _______ Hombre______ Hembra_____ Niños en edad escolar Hermanos_____________________________________________________________ (Por favor proporcionar nombres y apellidos) Nombre del Padre(s)/tutores legales____________________________________ Teléfono_________________ Localización de datos__________________________________________________________ Código postal__________ Firma de Padre/Tutor Legal_____________________________________________Fecha______________ Parte B 1. Es su dirección actual un temporal? _____ Sí _____No 2. Es este temporal cohabitación debido a la pérdida de la vivienda o las dificultades económicas? (Militares transiciones no constituyen una pérdida de vivienda o las dificultades económicas) _____Si _____No Si usted respondió que sí a tanto de las preguntas anteriores, rellene Parte C debajo. Parte C El estudiante vive (Elija Uno) _____ un motel/hotel _____ un refugio Nombre y ubicación de la vivienda___________________________________ _____ con más de una familia en una casa o apartamento _____ movimiento de un lugar a otro _____ un lugar no está diseñado para los dormitorios como un automóvil, parque, o camping Presentar registras falsas o falsificar registros es un delito en la sección 37.10, el Código Penal, y la inscripción del niño con falsos documentos temas la persona a la responsabilidad de la matrícula o otros gastos. TEC Sec. 25.002(3)(d). Parte D – Para Campus/Distrito Utilizar Sólo (For Campus/District Use Only) STUDENT ID (provided by campus) _________________ Please send a copy of those questionnaires that have been fully completed and only if the answers in Part B are both marked “Yes” to Shelley Brown at the Central Office. FAX: 254-547-4923 Homeless ______ Not Homeless _____ Date _____________ Per ___________________________________ 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 discriminan en base de la raza, del color, de la religión, del sexo, del origen nacional, disabilidad, de la edad, o empleo como lo requiere la ley. www.ccisd.com/ Facebook@Copperas Cove ISD/ Twitter @copperascoveisd Student Residency Questionnaire Spanish/8.2.12/Central Administration/SB Language Proficiency Assessment Committee (LPAC) COPPERAS COVE Texas Education Agency Curriculum Division 2012-2013 │ 52 Copperas Cove ISD Texas Education Agency Texas Public School Student/Staff Ethnicity and Race Data Questionnaire 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: Copperas Cove ISD Agencia de Educación de Texas Cuestionario de Información de Datos Raciales y de Etnicidad de Estudiantes/Miembros de Personal de las Escuelas Públicas de Texas El Departamento de Educación de Estados Unidos (USDE) requiere que todas las instituciones estatales y locales de educación, recopilen datos sobre etnicidad y raza de los estudiantes y de miembros de personal. Esta información es utilizada para los reportes estatales y federales así como para reportar a la Oficina de Derechos Civiles (OCR) y a la Comisión de Igualdad en el Empleo (EEOC). Al personal del distrito escolar y los padres o representante legal de estudiantes que deseen matricularse en la escuela, se le requiere proporcionar esta información. Si usted rehúsa proporcionarla, es importante que sepa que el USDE requiere que los distritos escolares usen la observación para identificación como último recurso para obtener estos datos utilizados para reportes federales. Favor de contestar ambas partes de las siguientes preguntas sobre la etnicidad y raza del estudiante así como del miembro de personal. Registro Federal de Estados Unidos (71 FR 44866). Parte 1. Etnicidad: ¿Es la persona Hispana/Latina? (Escoja solo una respuesta) Hispano/Latino – Una persona de origen cubano, mexicano, puertorriqueño, centro o sudamericano o de otra cultura u origen español, sin importar la raza. No Hispano/Latino Parte 2. Raza. ¿Cuál es la raza de la persona? (Escoja uno o más de uno) Indio Americano o Nativo de Alaska – Una persona con orígenes o de personas originarias de Norte y Sudamérica (incluyendo América Central), y que mantiene lazos o apego comunitario con una afiliación de alguna tribu. Asiático – Una persona con orígenes o de personas originarias del Lejano Este, Sureste de Asia o el subcontinente indio, incluyendo, por ejemplo a Cambodia, China, India, Japón, Corea, Malasia, Pakistán, las Islas Filipinas, Tailandia y Vietnam. Negro o Áfrico-Americano – Una persona con orígenes de cualquier grupo racial negro de África. Nativo de Hawai u otras islas del pacífico – Una persona con orígenes o de personas originarias de Hawai, Guam, Samoa u otras Islas del Pacífico. Blanco – Una persona con orígenes de personas originarias de Europa, el Medio Este o el Norte de África. ________________________________ Nombre del Estudiante/Miembro de Personal (por favor use letra de imprenta) ________________________________ Número de Identificación del Estudiante/Miembro del personal ________________________________ Firma (Padre/Representante legal) /(Miembro de personal ________________________________ Fecha 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: _____ Hispanic / Latino _____ American Indian or Alaska Native _____ Not Hispanic/Latino _____ Asian _____ Black or African American _____ Native Hawaiian or Other Pacific Islander _____ White Observer signature: Agencia de Educación de Texas – Marzo 2009 Campus and Date: COPPERAS COVE INDEPENDENT SCHOOL DISTRICT Student Health Information Sheet Campus Name: ___________________________ School Year 2014 to 2015 Student Name: _________________________________________________ Grade: Gender: Enrollment Date: _____________ DOB: ___________ Student's age: _____ Medicaid: Yes No Medicaid # Student SSN: ___________ Father/Guardian SSN:______________________ Mother/Guardian SSN: Address: __________________________________________________________________ Home Phone: Parent/Guardian: ________________________________Relation to Student: _____________ Work Phone: If military, Unit and Rank:________________________________ Alt Phone # : ________________________ Parent/Guardian: ________________________________Relation to Student: _____________ Work Phone: If military, Unit and Rank:________________________________ Alt Phone # : ________________________ To PARENTS/GUARDIANS: To best care for your child in case of an ACCIDENT or SUDDEN ILLNESS, it is necessary that you list a person or persons who will assume TEMPORARY CARE of your child if you cannot be reached. Name: _________________________________Phone # : ______________________ Alt Phone # __________________ Name: _________________________________Phone # : ______________________ Alt Phone # __________________ Name: _________________________________Phone # : ______________________ Alt Phone # __________________ HEALTH HISTORY: Please check any that apply to your child and have been diagnosed by a Physician. Please attach copies of any letters you have obtained from your child's physician regarding special health issues and recommendations for treatment and medication. Allergies _____ Asthma _____ Bladder/Kidney _____ Diabetes _____ Hearing _____ Heart Disease _____ Migraines _____ Seizures _____ Surgery _____ Vision _____ Other Is your child on any prescriptive medication(s)? NO _____ YES _____ If yes, state the name of the medication(s) and the reason it is being given Will the medication be given at school? NO _____ YES _____ Does the child wear glasses? NO _____ YES _____ Does the child wear a hearing aid(s) NO _____ YES _____ Is the child receiving speech therapy? NO _____ YES _____ NOTE: Prescription medication to be given at school must be in the original bottle with the child’s name and instructions for administration on the label. A permission form must be signed by the parent or guardian and kept on file in the nurse’s office. (See the CCISD Parent & Student Handbook for more information.) When a child suffers any injury or illness while in school, an immediate and continuing effort will be made to contact parents. In cases of serious injury or illness, first aid will be rendered in accordance with local school policies. EMERGENCY CARE PERMIT: If I cannot be reached by telephone in the event of an emergency involving my child, please send him/her to any available medical service. (If ambulance service is necessary, I will assume financial responsibility) I will not hold Copperas Cove ISD financially responsible for the emergency care and/or transportation of my child. Hospital Preferred _________________________________ Doctor Preferred 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. SIGNATURE OF PARENT OR GUARDIAN DATE PLEASE ENSURE THE NURSE HAS THIS FORM COPPERAS COVE INDEPENDENT SCHOOL DISTRICT Special Education Department Parent Information STUDENT NAME: CAMPUS: COPPERAS COVE HIGH SCHOOL DATE: GRADE: DOB: 1. With whom does the student live? a. ______ Natural/adoptive parent(s), legal guardian If the student lives with natural/adoptive parents or legal guardian, go to the signature. b. ______ Other family member (Indicate: ) If the student lives with an individual acting in the place of a natural or adoptive parent (including a grandparent, stepparent, or other relative), go to the signature. c. ______ Foster Family d. ______ Foster Group Home*** e. ______ Foster Therapeutic Home*** If the student lives in a foster home, ask the foster parent what type of license they hold. Their licensure will provide the above information. Complete page 2. f. ______ Other: g. ______ Wind Crest Nursing Center (Long Term Skilled Care Facility)*** If the student is an unaccompanied homeless youth and/or if the parents are not known, a surrogate parent must be appointed. 2. If the student is in a foster home, do the biological/adopted parents reside within the boundaries of the school district providing educational services to the student? _____ Yes Signature of Person Completing Form _____No Date *** Submit copy of these forms to the Special Education Director for RF Monitoring. Include date of entry at the facility: COPPERAS COVE HIGH SCHOOL SPECIAL PROGRAM EVALUATION/RELEASE Student’s Legal Name: __ Last ___________ - ___________ - ___________ Social Security Number __ First Grade Middle /_ / Date of Birth _____ Jr/III _ Date student withdrew from previous school: __________________ The student is registering with records: _____ Please check “Yes” if your child has been a part of any of the following programs during the past year and provide extra information as needed; otherwise, check “No”: Yes ___ No___ 1. Special Education Program? Please check appropriate program(s): ___Content Mastery ___Learning Disability ___Occupational Physical Therapy ___Vision/Hearing Services ___Behavioral Classes ___Other, please describe ___Resource ___Self-Contained ___Inclusion ___Speech ___Counseling Yes ___ No___ 2. Individual Education Plan (IEP)? Yes ___ No___ 3. Section 504 Services? If yes, please explain: Yes ___ No___ 4. English as a Second Language (ESL)? Yes ___ No___ 5. Gifted Education? If yes, what grade level(s)? Yes ___ No___ 6. Dyslexia? If yes, please explain: Yes ___ No___ 7. Home School? If yes, what curriculum was used and for what grade level(s)? Yes ___ No___ 8. Homebound services? If yes, what curriculum was used and for what grade level(s)? Yes ___ No___ 9. Private School? If yes, give the name of the school and dates of attendance: Parent / Guardian Signature Date Student Signature 400 South 25th Street ∎ Copperas Cove, Texas 76522 ∎ Voice (254) 547-2534 ∎ Fax (254) 547-9870 ∎ www.ccisd.com Acknowledgment of Electronic Distribution of Student Handbook My child and I have been offered the option to receive a paper copy of or to electronically access at www.ccisd.com the Copperas Cove ISD Student Handbook and the Student Code of Conduct for 2014–15. I have chosen to: Receive a paper copy of the Student Handbook and the Student Code of Conduct. Accept responsibility for accessing the Student Handbook and the Student Code of Conduct by visiting the web address listed above. I understand that the handbook contains information that my child and I may need during the school year and that all students will be held accountable for their behavior and will be subject to the disciplinary consequences outlined in the Student Code of Conduct. If I have any questions regarding this handbook or the Code of Conduct, I should direct those questions to the campus principal. Printed name of student: Signature of student: Signature of parent: Date: Use of Student Work in District Publications 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 these student projects in this manner. Parent: Please circle one of the choices below: I, parent of ______________________________ (student’s name), (do give) (do not give) the district permission to use my child’s artwork or special project on the district’s Web site and in district publications. Parent signature: ________________________________________ Date: Computer Usage Agreement A copy of the District’s Computer Usage Policy is included in this handbook. I understand the penalties if I do not comply with said rules and regulations. I understand that a letter must be submitted to my student’s campus principal within 10 ten days of the first day of school if I do not want my student to have computer access at school. Signature of student: Signature of parent: ______________________________________ Date: ii Notice Regarding Directory Information and Parent’s Response Regarding Release of Student Information State law requires the district to give you the following information: 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 the 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 your child’s first day of instruction for this school year. 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. The district is providing you this form so you can communicate your wishes about these issues. [See Directory Information on page 14 for more information.] iii For the following school-sponsored purposes: Copperas Cove ISD has designated the following information as directory information: Student’s name Address Telephone listing Photograph Date of birth Major field of study Degrees, honors, and awards received Dates of attendance Grade level Most recent school previously attended Participation in officially recognized activities and sports Weight and height, if a member of an athletic team Enrollment status Directory information identified only for limited school-sponsored purposes remains otherwise confidential and will not be released to the public without the consent of the parent or eligible student. Parent: Please circle one of the choices below: I, parent of ______________________________ (student’s name), (do give) (do not give) the district permission to use the information in the above list for the specified school-sponsored purposes. Parent signature Date Please note that if this form is not returned within the specified timeframe above, the district will assume that permission has been granted for the release of this information. iv For all other purposes, Copperas Cove ISD has designated the following information as directory information: Student’s name Address Grade level Parent: Please circle one of the choices below: I, parent of ______________________________ (student’s name), (do give) (do not give) the district permission to release the information in this list in response to a request unrelated to school-sponsored purposes. Parent signature Date Please note that if this form is not returned within the specified timeframe above, the district will assume that permission has been granted for the release of this information. v Parent’s Objection to the Release of Student Information to Military Recruiters and Institutions of Higher Education Federal law requires that the district release to military recruiters and institutions of higher education, upon request, the name, address, and phone number of secondary school students enrolled in the district, unless the parent or eligible student directs the district not to release information to these types of requestors without prior written consent. [See Release of Student Information to Military Recruiters and Institutions of Higher Education on page 14 for more information.] Parent: Please complete the following only if you do not want your child’s information released to a military recruiter or an institution of higher education without your prior consent. I, parent of ______________________________ (student’s name), request that the district not release my child’s name, address, and telephone number to a military recruiter or institution of higher education without my prior written consent. Parent signature Date Please note that if this form is not returned with the other materials identifying what the district considers directory information, the district will assume that permission has been granted for the release of this information. Student E-Mail Account Permission Students enrolled at Copperas Cove High School may receive e-mail accounts to complete online assignments. The school will provide directed supervision of e-mail accounts, and school or district personnel may monitor student accounts if the situation warrants it. Students are expected to abide by the rules noted in the Student Handbook. In instances of inappropriate e-mail use, the student’s account will be immediately and permanently discontinued. In addition, the student will be disciplined under the jurisdiction of the “Computer Use Policy.” Please complete the permission slip below and return it to your child’s teacher. Student e-mail accounts will only be issued once a signed permission slip is returned. If you do not want your child to have an e-mail account, please mark the appropriate box on the form. I would prefer that my son or daughter not be given an e-mail account. I give permission for my child, __________________________________, to receive an email account. I have discussed the above regulations with him or her. I understand that any inappropriate use will result in immediate and permanent removal of his or her account, and that he or she will be held accountable under the guidelines of the District’s “Computer Use Policy.” Parent signature ___________________________________________ Date ____________ I have read and understand the guidelines regarding student e-mail accounts. I agree to adhere to the guidelines, as well as the District’s “Computer Use Policy.” Student signature __________________________________________ Date ____________ vi For more information call: ESC Region 12 Contact Person Tani Menchaca: (254) 297-1253 Copperas Cove 2014-2015 Family Survey Please print Please return form to school office Campus: Student Name: Date:_____________ Grade:________ Father/Guardian:_______________________________ Mother/Guardian:________________________________ Father’s Place of Employment:___________________ Mother’s Place of Employment:__________________ Home Address City Home Phone: Zip Cell Phone: Work Phone: 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 answer the following questions. 1. Within the past 3 years have you moved from one city ,state or school district to another ? ☐YES or ☐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 or ☐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 on a poultry farm ☐ Working in a plant, nursery or orchard, growing or harvesting trees or picking pecans Other similar work, please explain: Working in a fishery ☐ ☐ 01-14/AAF ☐ Para mas información llame a: ESC Region 12 Contactase con Tani Menchaca: (254) 297-1253 Copperas Cove 2014-2015 Encuesta de Familia Por favor escriba con letra de molde Por favor devuelva esta Encuesta a la oficina de la escuela Nombre de campus escolar Fecha: Nombre del Estudiante Grado: Padre/Guardian:_______________________________ Madre/Guardian:________________________________ Empleo de la Madre: Empleo del Padre: Direccion de Casa: Cuidad: Telefono de Casa Codigo Postal: Telefono Celular:___________________ Telefono del Trabajo: ________________________________ Con el fin de servir mejor a sus hijos, el distrito escolar le gustaria identificar a los estudiantes que califican para recibir servicios educativos adicionales. La informacion se mantendra confidencial. Por favor, conteste las siguentes preguntas: 1. ¿En los ultimos 3 años se ha movido de una ciudad, Estado o de un distrito escolar a otro? ☐SI ☐NO o 2. Si la respuesta es SI, usted o sus hijos se movieron a fin de trabajar o buscar trabajo (ya sea temporalmente) en la agricultura o la pesca? (Seleccionando SI, esta indicando que usted ha trabajado en el trabajo de la agricultura o pesca dentro de los ultimos 36 meses.) SI o NO Si usted contesto si a la pregunta 2, por favor marque las que apliquen. Trabajando con fruta verduras, algodon, trigo, grano, granjas agricolas, campos o vinas ☐ Trabajando en fabrica de conservas ☐ Trabajando en una lecheria, en unranchoalimentando a animales, limpiando campos, construccion de cercas ☐ Trabajando en una matanza Empacando y cortando carne Trabajando en una granja de pollos ☐ ☐ Trabajando en guarderia de plantas o cultivo de arboles o recogiendo nueces ☐ Otrostrabajos similares, por favor explique: Trabajando en la pesca ☐ ☐ 01-14/AAF