Monroe School District Kindergarten Enrollment Checklist

www.monroe.wednet.edu Revised 3/2018

The following registration items must be completed in order to register your child for kindergarten in the Monroe School District.

Student Registration Form

Proof of Birthdate (i.e. birth certificate, entry in a family bible, adoption record, affidavit from a parent, previously verified school records)

Proof of Guardianship (if student lives with adult other than parent)

Proof of Residence (i.e. property tax statement, utility bill, lease or rental agreement)

Home Language Survey

Certificate of Immunization Status (CIS Form)

Student Medical Alert Form If your child has a life-threatening condition (i.e. asthma, diabetes, anaphylaxis, seizure, hemophilia) you must contact your school nurse for an appropriate care plan.

Student Housing Questionnaire (McKinney-Vento)

Student Placement Questionnaire for Kindergarten

Online Digital Resources Permission Form

Kindergarten Transportation Information

Optional

Free and Reduced Price Meal Application (if eligible)

Release of Directory Information Form

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Welcome To Monroe School District! Help us serve you better by using the Admission Checklist below as you collect the information and documents

necessary to enroll your child in Monroe School District.

Admission Checklist Forms (complete and return)

New Student Registration Complete all information below and on the following three pages and sign the form.

Certificate of Immunization Status (CIS) Washington State requires that you use the official CIS form, which must be signed by the parent/guardian. All immunization dates MUST appear on the CIS form! Sign and date.

Request for Transfer of Records between Schools

Documents/Forms (if applicable) Age Verification for Pre-K, Kindergarten, 1st Grade, new to Washington i.e. birth certificate, hospital or physician cert, etc. Court Documents (if applicable) relating to guardianship or a parenting plan (original for school to copy) Choice Transfer Request Form - students residing in another school district must have

Choice Transfer form approved before registering

New Student Registration

DO NOT WRITE IN SHADED AREA – FOR OFFICE USE ONLY Student School Number School Entry Date Homeroom Number Food Service Number Bus Route

AM PM

Has any member of your family ever been enrolled in or employed by the Monroe School District? Yes No

STUDENT: Legal Last Name Legal First Name Legal Middle Name Also Known As:

Birth Date (Month/Day/Year) Gender M F

Birth Place: City State Country Grade Level

RESIDENT DISTRICT: Is student attending Monroe School District via a Choice Transfer Yes No If Yes, what is your resident district?

HEALTH INFORMATION Health Care Provider/Clinic

Yes No Does your child have a condition which causes the daily possibility of a life‐threatening emergency? This includes life‐threatening allergies, diabetes, and some seizures.

If Yes, please describe

Yes No During school hours, does your child need help with a medical procedure? (Ex. Blood sugar, tube feeding, catheterization)

If your child has a life threatening health condition, an emergency care plan and medical treatment order must be in place prior to yourchild’s school attendance. Please contact your child’s school or Health Services at 360 804-2600 for assistance.

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HOME LANGUAGE SURVEY (State Law requirement): Indicate your language preference so we can provide an interpreter or translated documents (free of charge when you need them): _______________________________________________________

Indique el idioma de su preferencia para que podamos brindarle un intérprete o documentos traducidos, sin cargo alguno, cuando los necesite.

Укажите предпочитаемый язык, чтобы при необходимости мы могли бесплатно предоставить вам устного переводчика или переведенные документы. Вкажіть, якій мові ви віддаєте перевагу, щоб у разі потреби ми мали змогу безкоштовно організувати вам послуги усного перекладача або письмовий переклад документів.

Please complete a separate Home Language Survey form. (Available in 37 languages) Por favor complete separadamente un formulario de la Encuesta de Lenguaje en el Hogar

The Home Language Survey is given to all students enrolling in Washington schools. La Encuesta de idiomas en el Hogar se entrega a todos los alumnos que se inscriben en una escuela de Washington.

Анкета о языке домашнего общения выдается всем поступающим в школы штата Вашингтон. Опитування з рідної мови проводиться серед усіх учнів, які зараховуються до шкіл штату Вашингтон.

STUDENT RESIDENCY: The answers to the following questions can help determine the services this student may be eligible to receive under McKinney Vento Act 42 U.S. C. 11435.

Is this student’s home address a temporary living arrangement due to the loss of housing or economic hardship? Yes No

If you answered “Yes” to the above question: Please contact your school’s office to request a Student Residency Questionnaire

PRIMARY HOUSEHOLD: (parent/guardian #1 where student resides) Last Name First Name

Phone #1 (include area code) Home Work Cell

Please check if unlisted

Phone #2 (include area code) Home Work Cell

Please check if unlisted (parent/guardian #2 where student resides)

Last Name First Name Phone #1 (include area code)

Home Work Cell

Please check if unlisted

Phone #2 (include area code) Home Work Cell

Please check if unlisted Parent/Guardian #1 Relationship To Student

Mother Stepmother Grandmother Self Father Stepfather Grandfather Other Guardian Agency

Parent/Guardian #2 Relationship To Student Mother Stepmother Grandmother Self Father Stepfather Grandfather Other Guardian Agency

Email Address

Resident Address

Street Apt # City State ZIP

Mailing Address (If different from above)

Street Apt # P O Box City State ZIP

SECOND HOUSEHOLD: (non-custodial parent/guardian not residing with student) Last Name First Name

Phone #1 (include area code) Home Work Cell

Please check if unlisted

Phone #2 (include area code) Home Work Cell

Please check if unlisted (non-custodial parent/guardian not residing with student)

Last Name First Name Phone #1 (include area code)

Home Work Cell

Please check if unlisted

Phone #2 (include area code) Home Work Cell

Please check if unlisted NC Parent/Guardian #1 Relationship To Student

Mother Stepmother Grandmother Self Father Stepfather Grandfather Other Guardian Agency

NC Parent/Guardian #2 Relationship To Student Mother Stepmother Grandmother Self Father Stepfather Grandfather Other Guardian Agency

Email Address

Second Household Mailing Address Street City State Zip

Additional Mailings Requested Yes No

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SPECIAL SERVICES:Has your child ever qualified for or been enrolled in a special education program?

Yes No Has your child ever qualified for or had a 504 plan? Yes No Has your child ever participated in:

Title LAP Hi-Cap ELL Other _____________________

Has your child ever been retained? Yes No

If Yes, at what grade level(s)____________

SCHOOL: School Previously Attended School District Previously Attended Previous School Location (City and State)

Has student ever attended Monroe School District? Yes No If Yes, name of school attended

Date Attended (Month/Year)

OTHER INFORMATION: Is there a joint-custody or parenting plan in effect?

Yes No If Yes, plan must be on file with the school Original provided to school to copy and return Is there a restraining order in effect?

Yes No If Yes, legal papers must be on file with the school Original provided to school to copy and return

Restraining order is against: Mother Father Other _________________________________________________________

DISCIPLINE: Has the student ever been suspended or expelled? Yes No If Yes date: _______________________________

CHILD CARE: Does student attend child care? Yes No If Yes, check below and fill in child care information to right →

Before school After school Before & after school

Child Care Provider Name: ______________________________________ Address Phone Number

If you have additional child care arrangements, please provide information to school in writing.

OTHER SIBLINGS: Please list other siblings attending Monroe School District Last Name First Name School Grade

RELIGIOUS BELIEFS: If you have special instructions regarding religious beliefs, please provide information to school in writing.

EMERGENCY CONTACT INFORMATION: When injury, illness or other non-emergency situations occur involving your child, we want to be able to quickly reach families or other responsible adults. In the event we cannot reach a parent/guardian, please list persons you trust who are available during the day to provide care for your child. Primary Contact (Other Than Parent/Guardian) Last Name First Name

Relationship To Child Phone #1 (Include Area Code) Home Work Cell

Phone #2 (Include Area Code) Home Work Cell

Primary Contact Address Street City State Zip

Secondary Contact (Other Than Parent/Guardian) Last Name First Name

Relationship To Child Phone #1 (Include Area Code) Home Work Cell

Phone #2 (Include Area Code) Home Work Cell

Secondary Contact Address Street City State Zip

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MILITARY FAMILY STATUS (State Law requirement):

US Armed Forces active duty US Armed Forces reserves No affiliation

More than one member of Armed Forces/National Guard National Guard Member No response/refused to state

STUDENT ETHNICITY AND RACE: Instructions: This form is to be filled out by the student’s parents or guardians and both questions must be answered. Part A asks about the student’s ethnicity and Part B asks about the student’s race A. Is your student of Hispanic or Latino origin? Not Hispanic/Latino

If Yes, check all that apply Central American Puerto Rican Cuban South American Dominican Spaniard Latin American Other Hispanic/Latino Mexican / Mexican American/ Chicano

B. What race(s) do you consider your child? Check all that apply. Please circle your primary choice.

African American/ Black Native Hawaiian Makah Fijian Muckleshoot

White Guamanian Or Chamorro Nisqually Mariana Islander Nooksack

Asian Indian Melanesian Port Gamble Klallam Chinese Micronesian Puyallup Filipino Samoan Quileute Hmong Tongan Quinault Indonesian Other Pacific Islander Samish Japanese Sauk-Suiattle Korean Alaska Native Shoalwater Laotian Chehalis Skokomish Malaysian Colville Snoqualmie Pakistani Cowlitz Spokane Singaporean Hoh Squaxin Island Taiwanese Jamestown Stillaguamish Thai Kalispel Suquamish Vietnamese Lower Elwha Swinomish Other Asian Lummi Tulalip

Yakama Other Washington Indian Other American Indian/Alaska Native

STUDENT RELEASE AUTHORIZATION: In the event that the school is unable to contact the parent/guardian, I authorize that my child may be released to the person(s) listed under Emergency Contact Information.

EMERGENCY MEDICAL AUTHORIZATION: I understand that in the event of accident or illness, every effort will be made to contact parent/guardian immediately. If parent/guardian cannot be reached, I authorize school authorities to obtain emergency care for my child. VERIFICATION OF INFORMATION: The information on this form is true and accurate as of this date. I understand that falsification of information to achieve enrollment or assignment may be cause for revocation of the student’s enrollment or assignment to a school in the Monroe School District.

Legal Parent/Guardian Signature__________________________________________________ Please Print Name ______________________________________________________________ Date _____________________

Notice of Non-Discrimination

The Monroe School District does not discriminate on the basis of sex, race, creed, religion, color, national origin, age, honorably discharged veteran or military status, sexual orientation including gender expression or identity, the presence of any sensory, mental, or physical disability, or the use of a trained dog guide or service animal by a person with a disability in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups. A list of employees designated to handle questions and complaints of alleged discrimination are on our district website www.monroe.wednet.edu.

The Monroe School District will also take steps to assure that national origin persons who lack English language skills can participate in all education programs, services and activities.

English/November 2016

Office of Superintendent of Public Instruction (OSPI)

Home Language Survey

The Home Language Survey is given to all students enrolling in Washington schools.

Student Name: Grade: Date:

Parent/Guardian Name Parent/Guardian Signature

Right to Translation and All parents have the right to information about their child’s Interpretation Services education in a language they understand. Indicate your language preference so

we can provide an interpreter or 1. In what language(s) would your family prefer to communicatetranslated documents, free of with the school?charge, when you need them. __________________________________

Eligibility for Language

Development Support

Information about the student’s

language helps us identify students

who qualify for support to develop

the language skills necessary for

success in school. Testing may be

necessary to determine if language

supports are needed.

2. What language did your child learn first?

__________________________________

3. What language does your child use the most at home?

__________________________________

4. What is the primary language used in the home, regardless of

the language spoken by your child?

__________________________________

5. Has your child received English language development support

in a previous school? Yes___ No___ Don’t Know___

Prior Education

Your responses about your child’s

birth country and previous

education:

Give us information about the

knowledge and skills your child is

bringing to school.

May enable the school district to

receive additional federal funding

to provide support to your child.

This form is not used to identify

students’ immigration status.

6. In what country was your child born? ___________________

7. Has your child ever received formal education outside of the

United States? (Kindergarten – 12th grade) ____Yes ____No

If yes: Number of months: ______________

Language of instruction: ______________

8. When did your child first attend a school in the United States?(Kindergarten – 12th grade)

_______________________

Month Day Year

Thank you for providing the information needed on the Home Language Survey. Contact your school

district if you have further questions about this form or about services available at your child’s school.

Note to district: This form is available in multiple languages on http://www.k12.wa.us/MigrantBilingual/HomeLanguage.aspx. A response that includes a language other than English to question #2 OR question #3 triggers English language proficiency placement testing. Responses to questions #1 or #4 of a language other than English could prompt further conversation with the family to ensure that #2 and #3 were clearly understood. ”Formal education” in #7 does not include refugee camps or other unaccredited educational programs for children.

Forms and Translated Material from the Bilingual Education Office of the Office of Superintendent of Public Instruction are licensed under a Creative

Commons Attribution 4.0 International License.

Certificate of Immunization Status (CIS)

For Kindergarten-12th Grade / Child Care Entry

Please print. See back for instructions on how to fill out this form or get it printed from the Washington Immunization Information System.

Office Use Only: Reviewed by: Date:

Signed Cert. of Exemption on file? Yes No

Child’s Last Name: First Name: Middle Initial: Birthdate (MM/DD/YY): Sex:

____________________________________________________________________________________________________________________________________________________

I give permission to my child’s school to share immunization information with the Immunization Information System to help the school maintain my child’s school record.

______________________________________________________________ Parent/Guardian Signature Required Date

I certify that the information provided on this form is correct and verifiable.

______________________________________________________________ Parent/Guardian Signature Required Date

♦ Required for School and Child Care/Preschool Date Date Date Date Date Date ● Required Only for Child Care/Preschool MM/DD/YY MM/DD/YY MM/DD/YY MM/DD/YY MM/DD/YY MM/DD/YY

Documentation of Disease Immunity Healthcare provider use only

Required Vaccines for School or Child Care Entry

♦ DTaP / DT (Diphtheria, Tetanus, Pertussis)

♦ Tdap (Tetanus, Diphtheria, Pertussis)

♦ Td (Tetanus, Diphtheria)

♦ Hepatitis B 2-dose schedule used between ages 11-15

● Hib (Haemophilus influenzae type b)

♦ IPV / OPV (Polio)

♦ MMR (Measles, Mumps, Rubella)

● PCV / PPSV (Pneumococcal)

♦ Varicella (Chickenpox) History of disease verified by IIS

Recommended Vaccines (Not Required for School or Child Care Entry)

Flu (Influenza)

Hepatitis A

HPV (Human Papillomavirus)

MCV / MPSV (Meningococcal)

MenB (Meningococcal)

Rotavirus

If the child named in this CIS has a history of Varicella (Chickenpox) or can show immunity by blood test (titer) it MUST be verified by a healthcare provider

I certify that the child named on this CIS has:

a verified history of Varicella (Chickenpox).

laboratory evidence of immunity (titer) todisease(s) marked below. Lab report(s)for titers MUST also be attached.

Diphtheria Mumps Other: Hepatitis A Polio __________ Hepatitis B Rubella __________ Hib Tetanus Measles Varicella

Licensed healthcare provider signature Date (MD, DO, ND, PA, ARNP)

Printed Name

Instructions for completing the Certificate of Immunization Status (CIS): printing it from the Immunization Information System (IIS) or filling it in by hand.

To print with immunization information filled in: Ask if your healthcare provider’s office enters immunizations into the WA Immunization Information System (Washington’s statewide database). If they do, ask them to print the CIS from the IIS and your child’s immunization information will fill in automatically. You can also print a CIS at home by signing up and logging into MyIR at https://wa.myir.net. If your provider doesn’t use the IIS, email or call the Department of Health to get a copy of your child’s CIS: waiisrecords@doh.wa.gov or 1-866-397-0337.

To fill out the form by hand: #1 Print your child’s name, birthdate, sex, and sign your name where indicated on page one. #2 Vaccine information: Write the date of each vaccine dose received in the date columns (as MM/DD/YY). If your child receives a combination vaccine (one shot that protects against

several diseases), use the Reference Guides below to record each vaccine correctly. For example, record Pediarix under Diphtheria, Tetanus, Pertussis as DTaP, Hepatitis B as Hep B, and Polio as IPV.

#3 History of Varicella Disease: If your child had chickenpox (varicella) disease and not the vaccine, a health care provider must verify chickenpox disease to meet school requirements.

If your healthcare provider can verify that your child had chickenpox, ask your provider to check the box in the Documentation of Disease Immunity section and sign the form. If school staff access the IIS and see verification that your child had chickenpox, they will check the box under Varicella in the vaccines section.

#4 Documentation of Disease Immunity: If your child can show positive immunity by blood test (titer) and has not had the vaccine, have your healthcare provider check the boxes for the appropriate disease in the Documentation of Disease Immunity box, and sign and date the form. You must provide lab reports with this CIS.

Reference guide for vaccine abbreviations in alphabetical order For updated list, visit https://fortress.wa.gov/doh/cpir/iweb/homepage/completelistofvaccinenames.pdf Abbreviations

Full Vaccine Name

Abbreviations Full Vaccine

Name Abbreviations

Full Vaccine Name

Abbreviations Full Vaccine

Name Abbreviations Full Vaccine Name

DT Diphtheria, Tetanus Hep A Hepatitis A MCV / MCV4 Meningococcal Conjugate Vaccine

OPV Oral Poliovirus Vaccine

Tdap Tetanus, Diphtheria, acellular Pertussis

DTaP Diphtheria, Tetanus, acellular Pertussis

Hep B Hepatitis B MenB Meningococcal B PCV / PCV7 / PCV13

Pneumococcal Conjugate Vaccine

VAR / VZV Varicella

DTP Diphtheria, Tetanus, Pertussis

Hib Haemophilus influenzae type b

MPSV / MPSV4 Meningococcal Polysaccharide Vaccine

PPSV / PPV23 Pneumococcal Polysaccharide Vaccine

Flu (IIV) Influenza HPV (2vHPV / 4vHPV / 9vHPV)

Human Papillomavirus

MMR Measles, Mumps, Rubella

Rota (RV1 / RV5) Rotavirus

HBIG Hepatitis B Immune Globulin

IPV Inactivated Poliovirus Vaccine

MMRV Measles, Mumps, Rubella with Varicella

Td Tetanus, Diphtheria

Reference guide for vaccine trade names in alphabetical order For updated list, visit https://fortress.wa.gov/doh/cpir/iweb/homepage/completelistofvaccinenames.pdf Trade Name Vaccine Trade Name Vaccine Trade Name Vaccine Trade Name Vaccine Trade Name Vaccine

ActHIB® Hib Fluarix® Flu Havrix® Hep A Menveo® Meningococcal Rotarix® Rotavirus (RV1)

Adacel® Tdap Flucelvax® Flu Hiberix® Hib Pediarix® DTaP + Hep B + IPV

RotaTeq® Rotavirus (RV5)

Afluria® Flu FluLaval® Flu HibTITER® Hib PedvaxHIB® Hib Tenivac® Td

Bexsero® MenB FluMist® Flu Ipol® IPV Pentacel® DTaP + Hib + IPV Trumenba® MenB

Boostrix® Tdap Fluvirin® Flu Infanrix® DTaP Pneumovax® PPSV Twinrix® Hep A + Hep B

Cervarix® 2vHPV Fluzone® Flu Kinrix® DTaP + IPV Prevnar® PCV Vaqta® Hep A

Daptacel® DTaP Gardasil® 4vHPV Menactra® MCV or MCV4 ProQuad® MMR + Varicella Varivax® Varicella

Engerix-B® Hep B Gardasil® 9 9vHPV Menomune® MPSV4 Recombivax HB® Hep B

If you have a disability and need this document in another format, please call 1-800-525-0127 (TDD/TTY call 711). DOH 348-013 December 2016

2019/2020 Student Medical Alert Update

Health Services 081418

Student Name: _______________________________________ ____________ _______________________ Last First MI Date of Birth Grade/Teacher

Please complete this form and sign below. Student health information may be shared with school personnel in written, oral and electronic format on a need-to-know basis and as necessary to safeguard your child’s health. Please provide the health room with any updates.

No physical health concerns No medications taken at school

Allergies list allergen & reaction (Physician-confirmed) Environmental ___________________________ Food __________________________________ Insect __________________________________ Drug __________________________________ Other __________________________________ Epi-Pen prescribed Needs ALLERGY medication at school_______ No ALLERGY medication needed at school

Asthma (Physician-confirmed) Needs ASTHMA medication at school________ Diagnosed, but no ASTHMA medication needed

at school

ADD/ADHD Needs ADD/ADHD medication at school _____ Takes ADD/ADHD medication at home only __ Diagnosed, but not taking medication

Cardiovascular Condition _______________________________________

Congenital Condition _______________________________________

Diabetes Diagnosed ___/___/____ Insulin dependent Non- insulin dependent

Gastro-Intestinal Condition ______________________________________

Mental Health Condition Anxiety Depression Autism Asperger’s Syndrome Other _________________________________

Migraine Headaches Needs MIGRAINE medication at school _____ Diagnosed, but no need for MIGRAINE

medication at school

Hearing Wears hearing aid(s)_____________________ Diagnosed hearing loss at age______________

Renal (Urinary) Condition ___________________________________

Seizures/Neurological Condition Needs SEIZURE medication at school _______ Takes SEIZURE medication at home ________ History of seizures, but not presently medicated

Date last seizure occurred ___/___/____ Other neurological condition_______________

______________________________________

Vision Corrected with prescription lenses Other concern __________________________

Other Other health concern that may affect school

performance/attendance_________________________________________________________

Medication your child needs at school notalready listed ___________________________

Physical restrictions ___________________________________________________________

NOTE: If medication is needed, parent and health care provider must complete an Authorization for Administration of Medication at School form before medication can be given at school. Students 12 years and older may carry and self-administer medications according to provisions of BP 5432 Medication at School. Please contact school nurse for additional information. Student Treatment and Release Authorization: I understand that in the event of an accident or illness, every effort will be made to contact my child’s parent/guardian. If the parent/guardian cannot be reached, I authorize and direct school authorities to obtain emergency care for my child. Should the illness or injury not be an emergency and the parent/guardian cannot be reached, I authorize school staff to release my child to the alternate contact person I have designated.

Parent/Guardian Signature ________________________________________ Date __________________

Student Housing Questionnaire

The answers to the following questions can help determine the services this student may be eligible to receive under the

McKinney-Vento Act 42 U.S.C. 11435. The McKinney-Vento Act provides services and supports for children and youth

experiencing homelessness. (Please see reverse side for more information)

If you own/rent your own home, you do not need to complete this form.

If you do not own/rent your own home, please check all that apply below. (Submit to District Homeless Liaison. Contact

information can be found at the bottom of the page).

In a motel A car, park, campsite, or similar location

In a shelter Transitional Housing

Moving from place to place/couch surfing Other________________________________

In someone else’s house or apartment with another family

In a residence with inadequate facilities (no water, heat, electricity, etc.)

Name of Student:

First Middle Last

Name of School: Grade: Birthdate (Month/Day/Year): Age:

Gender: Student is unaccompanied (not living with a parent or legal guardian)

Student is living with a parent or legal guardian

ADDRESS OF CURRENT RESIDENCE:

PHONE NUMBER OR CONTACT NUMBER: NAME OF CONTACT:

Print name of parent(s)/legal guardian(s):

(Or unaccompanied youth)

*Signature of parent/legal guardian: Date:

(Or unaccompanied youth)

*I declare under penalty of perjury under the laws of the State of Washington that the information provided here is true and correct.

Please return completed form to: Your school counselor _______________________________________________

Counselor’s Name/Signature

OR:

Ginnie Ayres, Director Instructional Support Programs 360-804-2558 District Office

District Liaison Phone Number Location

For School Personnel Only: For data collection purposes and student information system coding

(N) Not Homeless (A) Shelters (B) Doubled-Up (C) Unsheltered (D) Hotels/Motels

McKinney-Vento Act 42 U.S.C. 11435

SEC. 725. DEFINITIONS.

For purposes of this subtitle:

(1) The terms enroll' and enrollment' include attending classes and participating fully in school activities.

(2) The term homeless children and youths' —

(A) means individuals who lack a fixed, regular, and adequate nighttime residence (within the

meaning of section 103(a)(1)); and

(B) includes —

(i) children and youths who are sharing the housing of other persons due to loss of

housing, economic hardship, or a similar reason; are living in motels, hotels, trailer parks,

or camping grounds due to the lack of alternative adequate accommodations; are living in

emergency or transitional shelters; are abandoned in hospitals;

(ii) children and youths who have a primary nighttime residence that is a public or private

place not designed for or ordinarily used as a regular sleeping accommodation for human

beings (within the meaning of section 103(a)(2)(C));

(iii) children and youths who are living in cars, parks, public spaces, abandoned buildings,

substandard housing, bus or train stations, or similar settings; and

(iv) migratory children (as such term is defined in section 1309 of the Elementary and

Secondary Education Act of 1965) who qualify as homeless for the purposes of this

subtitle because the children are living in circumstances described in clauses (i) through

(iii).

(6) The term unaccompanied youth' includes a youth not in the physical custody of a parent or guardian.

Additional Resources

Parent information and resources can be found at the following:

National Center for Homeless Education

National Association for the Education of Homeless Children and Youth (NAEHCY)

SchoolHouse Connection

200 E. Fremont Street • Monroe, WA 98272 • (360) 804-2500 • http://www.monroe.wednet.edu

Online Digital Resources Student Permission

Dear Parent(s)/ Guardian(s):

In the Monroe School District, a variety of technology and online educational resources are used to allow students access to their own student work and data from almost any networked device, at any given time. Technology is used to enhance the learning experience; augment learning in the classroom; provide for productivity tools to create, store and organize work; communicate with teachers; and collaborate on school projects inside and outside of the school day. Appropriate access and full utilization of these tools hinges on the cooperation of students with the support of parent(s)/ guardian(s). As a result, we are providing parent notification and requiring parents to give permission. Students under the age of 18 must have parental or legal guardian consent to be able to have full access to all of the digital and online resources. Online content is used to enhance the student’s educational experience and develop safe, lifelong, technology skills.

We live in a global and digital world -- a world changed by technology and new ideas about how we communicate with one another. In the Monroe School District (MSD), we realize that students must develop the research, information fluency, and technology skills that will allow them to be successful in this digital world, as well as the skills necessary to live safely and ethically. Because of this, MSD provides computer access privileges, as well as access to the Internet, email, digital communication and collaboration tools, online learning spaces, and electronic educational resources. These resources, tools, and equipment are essential to teaching and learning. The stipulations for responsible use of these tools and digital citizenship are outlined in School Board Policy and Procedure 2022, which can be found here:

● Policy 2022: Electronic Resources and Internet Safety● Procedure 2022: Electronic Resources and Internet Safety

Standard applications and accounts that are configured for student use include (but are not limited To):

● Active Directory: Each student is given an account in Active Directory that they will use to log onto any district-owned computer within the district network and provide them with access toeducational resources that support their learning program.

● MSD Google Apps for Education Environment: This education-focused Google Appsenvironment is hosted by Google, and managed by the MSD. This collection of onlineapplications provides students with a Google email account, calendar, and access to Googledrive, where students can create, share, and publish documents, spreadsheets, presentations,and other artifacts of their learning. MSD creates and manages user accounts; manages accessto applications and email based on grade level organizations; and manages permissions.Students should only use their district Google Accounts for school assignment purposes only.There should not be an expectation of privacy by the student when using their Google account.

Digital Learning 061518

The District reserves the right to review and suspend an account if violation of the Electronic Resources and Internet Safety Policy and Procedure 2022 is suspected. Through ongoing training, students will be taught that anything written or stated within the Google account should be treated with the same proper behavior expected publicly in their classroom, in the presence of peers and staff.

● Office 365 Student Microsoft Tool: Office 365 will be provided this your for specific grade level coursework. As we learn from these targeted classrooms, we may provide this tool district wide as another suite of educational tools that students can access from any networked device. This tool is a digital suite of tools that brings conversations, collaboration, content, assignments, and apps together in one place.

● Online Curriculum Systems: Most of the curriculum adopted in the District is accompanied by or

relies on access to an online system where content and assessments are stored. Many of these systems require students to have a unique account created for them which allows them to access supplemental video content, take quizzes, and strengthen their understanding about the ideas in a content area. For approved district curriculum, MSD creates and manages these accounts. In these cases, the terms of use and privacy policies are reviewed thoroughly before providing any student account data to the vendor.

● Online Educational Websites (those that require a student login or tracks student progress): Many teachers use additional websites that require a student log in, yet enhance the learning experience of students. Permission only applies for sites that require a student login, collecting basic information such as name of the student and their email address to send a password confirmation to access the site. Secondary students can email peers for collaborative purposes. Please visit our “Vetted Website and Digital Resources” list. This list will show what has been reviewed and updated as well as approved status.

Under the Federal Children’s Internet Protection Act (CIPA), the District is required to filter Internet access and to teach online safety. The District takes your student’s safety and privacy very seriously and makes every effort to supervise and monitor student technology use. We use Internet filtering software to block access to content that is obscene, pornographic, and harmful to minors. We provide instruction to all students in the area of digital citizenship and online safety through use of district-approved curriculum from Common Sense Media as well as other supportive materials.

The Student User Privacy Educational Rights (SUPER) Act (Chapter 28A.604 RCW) requires districts to provide notification to parents about collection and use of student data by vendors who supply online curriculum or educational resources used by the District. MSD reviews these sites that require a student login or collects information from a student to create a log-in for compliance with the SUPER Act, CIPA, and the Family Educational Rights Privacy Act (FERPA). We want to assure you that we take cyber safety of our students very seriously and take necessary precautions as required by state and federal law.

Providing digital resources, technology, and proper utilization of these online educational tools is a partnership among our schools, students and parents. As such, please indicate whether or not you allow your student to have full access to the technology and online resources used for your student’s educational program. If permission is not provided, students will be given alternative means to complete assignments. If the student abuses these resources or violates the Electronic Resources and Internet Safety Procedure, access to utilizing the network, the technology, and online resources will be suspended at the discretion of the building administrator.

Thank you for your partnership in your student’s educational experience.

Digital Learning 061518

_____ I give permission for my student to have full access to district-approved digital resources including a Google Apps account and in limited cases, an Office 365 account that will support their educational experience in MSD. _____ I DO NOT give permission for my student to have full access to district-approved online education resources. I understand that this will impact my child’s full educational experience. I also understand this means my child may need to complete alternate assignments. Parent signature: _____________________________________________________ Student name (Please print):____________________________________________ Last Name , First Name, Middle Initial School_______________ Grade_______________ Notice of Non-Discrimination. The Monroe School District does not discriminate on the basis of sex, race, creed, religion, color, national origin, age, honorably discharged veteran or military status, sexual orientation including gender expression or identity, the presence of any sensory, mental, or physical disability, or the use of a trained dog guide or service animal by a person with a disability in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups. The following employees have been designated to handle questions and complaints of alleged discrimination: Title IX Coordinator, Joanne Dickinson (360.804.2539), Section 504/ADA Coordinator, David Paratore (360.804.2609), and Compliance Coordinator, Joanne Dickinson (360.804.2539). The Monroe School District will also take steps to assure that national origin persons who lack English language skills can participate in all education programs, services and activities. For information regarding translation services or transitional bilingual education programs, contact Ginnie Ayres (360.804.2558).

Digital Learning 061518

Operations & Support Services

Revised for 2018/2019

Student Placement Questionnaire for Kindergarten

Dear parents, we want your child’s adjustment to their new school to be a

positive experience so please take a moment to help us know your child better.

Student’s Name:

Parent’s Name: Phone Number:

Have you applied for Dual Language Program? YES NO

Have you applied for Montessori Program? YES NO

Have you applied for an Intra District transfer to another school? YES NO

Do you live within the Monroe School District boundary? YES NO

If no, you will need to fill out a Choice Transfer form that must be signed by superintendent/designee of your resident

district.

Has your child attended a preschool? YES NO

If yes, please put the name of the preschool your child attended:

Has your child experienced any major changes or events, which may affect his/her adjustment to school? (Please

explain)

Do you have concerns about your child’s readiness for school, speech or hearing? If so, would you be interested in

speaking with a staff member (i.e., nurse, school counselor or specialist)?

Does your child have any diagnosed health concerns (e.g., bee or nut allergy, asthma, diabetes, etc.)?

Has your child ever qualified for or been enrolled in a special education program? Has your child ever qualified for or

had a 504 plan?

Operations

01/30/2017

Kindergarten Transportation Information

School: _____________________ for the 20____/ 20____ school year

Student Name: __________________________________________________

Address: ______________________________________________________ City State Zip

Parent Name: __________________________________________________

Home Phone: _______________ Father’s Contact Phone: ______________

Mother’s Contact Phone: _____________

Is student attending current school via intra district transfer? (Please √)Yes____ No____

If yes, will student be accessing the nearest bus stop/express bus if seats are available? (Please

√)Yes____ No____

Local emergency contact names, addresses and phone numbers:

1st Person: _______________________________________________________________

2nd Person: ______________________________________________________________

Before school my child will be transported from (Please √) Home____ Daycare____

After school my child will be transported to (Please √) Home____ Daycare____

If transported to or from daycare, please list the name, address and telephone of daycare:

Daycare name: _______________________________ Phone: _____________________

Daycare address: _____________________________________ Zip code: ___________

Days of the week child needs transportation to daycare? (i.e., MWF)__________________

Are there any concerns that we should be aware of? ______________________________

Your child will not be let off the bus without an adult or an older sibling present. Please list

names and phone numbers of adults who have permission to pick-up your child.

Name: _____________________________________ Phone #:_____________________

Name: _____________________________________ Phone #:_____________________

Name: _____________________________________ Phone #:_____________________

Name: _____________________________________ Phone #:_____________________

Transportation

Use Only:

Kindergarten: Bus route: To: ______________ From: _______________

Office

Use

Only:

Student has Intra or Inter District Transfer on file

Student’s Resident School :

Student’s Requested School:

Other ID:

Request for Transfer of Records Between Schools

Transferring Student Student Name Date of Birth Grade

Records to Transfer (Please check records requested) Cumulative Record File WA State History CIS (Immunization record) State Testing Scores (i.e. WASL, HSPE, MSP) Other (i.e. Excel, AP) Official signed transcript with exit date

or unofficial transcript with fine owed report If applicable, please send 504 Plan Becca/Attendance Issues IEP Discipline

School Student is Transferring from School Name Street Address City State Zip Fax Phone

Parent/Guardian Consent and Information I acknowledge notification of this transfer of records as required by the Family Education Rights and Privacy Act of 1974 and understand that I have a right to receive a copy at my own expense, if requested, and have an opportunity for a hearing to challenge the content of the records. I understand that the information transferred will be treated in a confidential manner and will not be transmitted to a third party without my consent.

Parent/Guardian’s Signature

Parent/Guardian’s Name Printed Street Address City State Zip Date Signed

Please Send Records to

School Name Attention Street Address City State Zip Phone Fax Comments

030811 Operations