Page 7 of 7
Application for Boarding 7th-12th & Day Students Grades K-12th
Crow Creek Admissions Application Check List
ALL APPLICATIONS MUST HAVE THE FOLLOWING LIST OF DOCUMENTS. THE ADMISSIONS COMMITTEE WILL NOT REVIEW INCOMPLETE APLICATIONS.
STUDENT______Grade applying for______
Date______School Year______
Page 7 of 7
Page 7 of 7
qStudent Enrollment Form Fill out and sign
qDay Student Check Out Form (Notarized/Mandatory)
q Social History Form Fill out and sign
qPermission/Participants Consent Forms Fill out and sign
qBIE McKinney-Vento Enrollment Form Fill out and sign
qFERPA Sign & Date
The following documents are required before the application can be processed.
Copy of State Issued Birth Certificate / Copy of Social Security CardCopy of Certified Degree of Indian Blood
(Tribal membership card not accepted) / Copy of Health/Medical Insurance Cards
Physical Forms (if participating in sports) / Immunization Records
ALL students must provide final report cards and/or Transcripts as of May 2016 / Court Appointed or Legal Guardian MUST provide LEGAL DOCUMENTATION.
The first day of school is September 1, 2016. To be considered for Perfect Attendance, Awards and Academic Honors you must be present on September 1.
STUDENT ENROLLMENT APPLICATION
FOR Crow Creek Tribal Schools
Name of Student: (Last) (First) (Middle)Address: P.O. Box Street:
City: State: Zip Code
Date of Birth: Month Day Year Sex: Male ( ) Female ( )
Social Security Number______
Tribal Affiliation: Degree of Indian:
Enrollment Number: Home Agency:
Dominant Language spoken in the home:
(1) (2)
FAMILY INFORMATION
IMPORTANT-PLEASE NOTIFY THE ADMISSIONS OFFICE IMMEDIATELY IF ADDRESS OR PHONE NUMBERS CHANGE.
Father/Guardian
Address:
Occupation (Optional) Employer:
Telephone Home:
Cell Phone:
Work:
E-mail:
Other (Specify): / Mother/Guardian
Address:
Occupation (Optional) Employer:
Telephone Home:
Cell Phone:
Work:
E-mail:
Other (Specify):
Emergency Contact
Phone No.
Relationship to Student / If you are a court appointed custodial parent or guardian, you must attach the appropriate documentation
I affirm that all information on this form is accurate to the best of my knowledge
______
Parent/Guardian Signature Parent/Guardian Print Date
Student NameEDUCATIONAL INFORMATION
1. List school previously attended:
2. Previous school contact number:
3. Reason for leaving:
4. Did student miss 15 or more days in the last school year? ( )Yes ( ) No
5. Has student ever been suspended? ( ) Yes ( ) No Expelled? ( ) Yes ( ) No
If yes date and reason must be given:
6. Has student participated in Special Education Program? ( ) Yes ( ) No
7. Has student participated in Talented and Gifted Program? ( ) Yes ( ) No
8. Will your student participate in sports? ( ) Yes ( ) No
If so complete ALL sports/physical information forms.
SOCIAL INFORMATION
1. Is student a ward of the court? ( ) Yes ( ) No
If yes a copy of the court order must be submitted.
2. Has student ever been arrested? ( ) Yes ( ) No
If yes what was/were the violations?
3. Has student ever been in jail or a detention center? ( ) Yes ( ) No
If yes how many times?
4. Does student have a probation officer? ( ) Yes ( ) No
Name______
County______
Phone______
5. Has student ever received counseling? ( ) Yes ( ) No
Name______
Phone______
I affirm that all information on the above mentioned student is true and accurate to the best of my knowledge. Any false statement or misrepresentation or omission of required information in this application will result in denial of this application.
______
Student Signature Parent/Guardian Date
Crow Creek Tribal Schools/Transcripts/Records Release
High School/Middle School
101 Crow Creek Loop
Stephan, SD 57346
Telephone: 1-800-370-7908 Fax: Registrar 605-852-2573
*Please complete and submit to the last school the student has attended. These records need to be sent to Crow Creek High School immediately.
Student Name: ______
Last First MI
Address:______City:______State:______Zip______
Home Phone:______Cell or emergency #______
I authorize the Principal, Counselor, Registrar and Special Education staff at:
Name of Previous School attended: ______
Address of Previous School:______City:______State:______Zip______
Dates Attended: ______to ______
Month/Year Month/Year
To release the following information: Crow Creek Tribal Schools
Page 7 of 7
· Transfer Grades
· Last Report Card
· Transcripts
· Attendance
· Behavior Report
· Standard Test Results
· English Language Proficiency
· 504 Plan, Talented and Gifted Records
· Immunizations,
· Birth Certificate
· Degree of Indian Blood
Page 7 of 7
· Special Education Records-please include: current or last IEP, Parental Consent, Team Summary, Evaluation Report, Current Psychological Evaluation Report
· Other if any:______
______
Student Signature Parent/Guardian Signature Date
FEDERAL LAW 99-31-*THERE IS NO PARENT SIGNATURE REQUIRED FOR EDUCATION RESOURCES TO BE SENT TO ANOTHER AGENCY.*
Crow Creek Tribal Schools
Campus Portal Acceptable Use Policy
Crow Creek Tribal Schools has developed a Campus Portal as a means to further promote educational excellence and to enhance communication with parents and students. The Campus Portal allows parents and students (Grades K-12) to view school records anywhere at any time. In response for the privilege of accessing the Crow Creek Tribal Schools Campus Portal, every parent and student is expected to act in a responsible, ethical and legal manner. The Campus Portal is available to every parent or guardian who has a student enrolled at Crow Creek Tribal Schools. Parents and students are required to adhere to the following guidelines.
1. Parents and students will not share their passwords with anyone, including their children or
classmates.
2. Parents and students will not attempt to harm or destroy data of their own children, of
another user, school or district network, or the Internet.
3. Parents and student will not use the Campus Portal for any illegal activity, including
violation of Data Privacy laws. Anyone found to be violating laws will be subject to Civil
and/or Criminal Prosecution.
4. Parents and students will not access data or any account owned by another parent or student
5. Parents and students who identify a security problem with the Campus Portal must notify
the Schools Technology Coordinator immediately (852-2993) or ()
without demonstrating the problem to anyone else.
6. Parents and students who are identified as a security risk to the Campus Portal will be
denied access to the Campus Portal.
User guidelines and system requirements can be found at www.crowcreek.k12.sd.us. Please review them before signing and returning this document. You are required to sign and return this agreement before you receive access to the Campus Portal. Students must both sign and have a parent signature to gain access to the Campus Portal.
Please fill in all blanks (Print)
Parent(s) Name: ______
Email Address: ______
Children Information
Name: ______Grade: ______
Name: ______Grade: ______
Name: ______Grade: ______
I have read the Campus Portal Acceptable Use Policy and I agree to abide by and support these rules.
I understand that if I violate any terms of this Acceptable Use Policy that I may lose my privilege to use the Campus Portal, and may be liable for civil and/or criminal consequences.
Student Signature ______Date: ______
Parent Signature: ______Date: ______
Crow Creek Tribal Schools
· Permission Form for Internet Usage in Classroom and Dormitory
· Photo Release
· Religion of Choice Consent
Students at CCTS have access to the internet in computer related classes, as well as in the dormitory
ü There are strict rules for Internet usage by students. As a school system we attempt to block out as many inappropriate sites as possible, but as you may have read or heard, this can be difficult at times.
ü In order for your child to be allowed any contact on the internet, we need to have your permission. Please understand that due to certain circumstances your student may access an inappropriate site. We will not be held liable for any such occurrences.
ü If it is proved that a student has misused the internet or e-mail services, their privileges may be revoked for the remainder of the school year.
Please check on of the following:
_____I Do Not Give Permission for my child to be on the internet. _____I Do Give Permission for my child to be on the internet.
I also give permission to use my child’s picture on your website. I understand that staff will monitor student use of the internet and agree not to hold the school liable for any unintentional incident of my child viewing an inappropriate site.
Student:______Parent:______Date______
******************************************************************************
PHOTO Release Form
All photographers taking photographs or on Crow Creek Tribal Schools property or of Crow Creek Tribal School Events or student works must obtain a signed release form from any student, faculty member, staff person who is visibly recognizable in the photograph. crowd scenes where not single person is the dominate feature are exempt.
These rules govern photographs intended for use in any Crow Creek Tribal School publication of marketing or a public relations nature, such as newsletters, brochures, yearbooks, promotional items, or other such material. Releases also must be obtained for photographs used on the Web. These rules are not in effect when photographs are taken on news events, but photographs taken for news purposed required a release for reuse in marketing materials.
PLEASE CHECK ONE
______I DO give my consent for Crow Creek Tribal School to interview me or my child (name listed below) to use in photograph(s) video in any and all of its publications and in any and all media for use but the Crow Creek Tribal School. I will make no monetary or other claim against Crow Creek Tribal School for the use of the interview and/or the photographs(s) video.
______I DO NOT give my consent for Crow Creek Tribal School to interview me or my child (name listed below, to use in photograph(s)/video in any and all of its publications.
Name of child (Please Print)______
Parent/Guardian (Please Print)______
Parent/Guardian Signature______
Relationship to child (if child is a minor)______
******************************************************************************
Ø Religion of Choice Consent
I, _____ Give Consent _____ Do Not Give Consent - For my child to participate in sweat lodge ceremonies or attend the church of their choice for purposes of purification, prayers or personal spiritual guidance while attending CCTS. My child’s religion affiliation is:______
Student:______Parent:______Date______
Page 18 of 18
Crow Creek Tribal Schools
Day Students Check out Form 2016/2017
(Dorm Students must use the Dorm Check-Out Form when checking out during school)
It is very important the Parent/Legal Guardian have this form complete and notarized for the safety of our students. Students will not be allowed to check out of the dormitory or school unless they are released to a person whose name appears on this permission form. Any other special circumstances will have to be referred to a Principal, Dormitory Supervisor or Superintendent.
______
Student Name Home Reservation
______
Parent/Legal Guardian Phone # you can be reached at immediately
______
PO Box/Address City State Zip
· I hereby give the following adults permission to check out my son/daughter for week-ends or holidays.
· I understand that these adults must personally pick up the student and sign him/her out from the school (if during school hours) and from the dormitory.
· I understand that off reservation students may not check out to Ft. Thompson and surrounding communities for overnight unless with parents or legal guardian.
(Handwriting must correspond to notarized signatures at bottom of the page)
______
______
______
______
I also give the school permission to seek out adequate housing and transportation for my son/daughter during emergencies.
______
Signature of Parent/Legal Guardian Verified by Notary of the Public
______
My Commission Expires on
Family Education Rights and Privacy Act (FERPA)
The Family Education Rights and Privacy Act of 1974, commonly known as FERPA, is a federal law that protects the privacy of student education records. Students have specific, protection rights regarding the release of such records and FERPA requires that institutions adhere strictly to these guidelines.
The following are statements that reflect what the Family Education Rights and Privacy Act (FERPA) covers concerning your rights as a parent and student:
· Parents are allowed to review all files and material the school has about their child.
· All schools are required to follow FERPA.
· The schools cannot provide a student with his/her parent’s financial records.
· A student can request that doctor of his/her choice review psychiatric or treatment records.
· FERPA does not allow the students to see the same files and records that their parent can see.
· A probation officer cannot see a student’s educational records without parental consent.
· The school is required to keep a list of all people who access a student’s records.
· Parents are allowed to bring someone with them to review their child’s school records.
· Parents are allowed to review their child’s testing protocols.
· Student Special Education records are the school’s responsibility to safeguard and no file should ever be left out of place where they can be seen by unauthorized people.
· Staff members can be reprimanded for failure to safeguard student records.
If you have further questions on your rights under the FERPA law then please feel to contact the school or visit the www (world wide web) and do a search on FERPA. This will pull up the law, its interpretation and how it affects you as a parent/student.
By initialing this form I have read all the above information.
______
Parent/Guardian Date
Crow Creek Tribal Schools
BIE McKinney-Vento Enrollment/Referral/Residency Form
The Purpose of this form is to address the requirements of the McKinney-Vento Act, Title X. This Document will be used to share with school staff and partnering agencies to ensure all providers have the necessary information to support the child and his/her family.
Student Name: ______( ) Male ( ) Female
Please check only ONE that best describes where the student is presently living (Please specify name of hotel, shelter, or organization providing the transitional housing)
q In my own home or apartment