YES - Copperas Cove ISD
Transcripción
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