Items Required for Enrolling New Students in CCISD Copperas

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_______
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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