Student Violence, Bullying, Intimidation, Harassment

Save this PDF as:
 WORD  PNG  TXT  JPG

Tamaño: px
Comenzar la demostración a partir de la página:

Download "Student Violence, Bullying, Intimidation, Harassment"

Transcripción

1 Case 4:74-cv DCB Document Filed 10/01/14 Page 159 of 229 Student Violence, Bullying, Intimidation, Harassment COMPLAINT FORM (To be filed with any School District employee who will forward this document to the principal or principal s designee, the site director and Charlotte Brown-Dept. of Student Equity) Please Print Name Date Address Telephone During the hours of Another phone where you can be reached Address I wish to complain against: Name of person(s) Specify your complaint by stating the problem as you see it. Describe the incident, the participants, the background to the incident, and any attempts you have made to solve the problem. Be sure to include all relevant dates, times and places. Additional pages may be attached if necessary. JICK-E1 Revised: Appendix VI-24 p. 1

2 Case 4:74-cv DCB Document Filed 10/01/14 Page 160 of 229 If there is anyone who could provide more information regarding this complaint, please list name(s), address(es) and telephone number(s). Name Address Telephone Number The projected solution: Indicate what you think can and should be done to solve the problem. Be specific as possible. I certify this information is correct to the best of my knowledge. Signature of Complainant Date Document Received by Date Investigation Official Date JICK-E1 Revised: Appendix VI-24 p. 2

3 Case 4:74-cv DCB Document Filed 10/01/14 Page 161 of 229 PRINCIPAL S REPORT ( to be sent to the site director and Charlotte Brown-Dept. of Student Equity) Findings: Determination: Corrective Action: JICK-E1 Revised: Appendix VI-24 p. 3

4 Case 4:74-cv DCB Document Filed 10/01/14 Page 162 of 229 Student Violence, Bullying, Intimidation, Harassment Complaint Form - Spanish Violencia Estudiantil, Hostigamiento, Intimidacion, Acoso FORMULARIO DE QUEJA (Para presentarse a cualquier empleado del Distrito Escolar que remitirá este documento al director o persona designada por el director, el director del sitio y a Charlotte Brown del Departamento de Equidad Estudiantil) Por favor escriba con letra de molde Nombre Fecha Dirección Teléfono Durante el siguiente horario Otro número donde se le puede localizar Dirección de correo electrónico Deseo presentar una queja contra: Nombres de la persona (s) Especifique su queja indicando el problema como usted lo ve. Describa el incidente, los participantes, los antecedentes del incidente y cualquier intento que usted haya hecho para resolver el problema. Asegúrese de incluir todas las fechas, horas y lugares pertinentes. Se pueden adjuntar páginas adicionales si es necesario. JICK-E1 Revised: Appendix VI-24 p. 4

5 Case 4:74-cv DCB Document Filed 10/01/14 Page 163 of 229 Student Violence, Bullying, Intimidation, Harassment Complaint Form - Spanish Si hay alguna persona que podría proporcionar más información sobre esta queja, por favor, indique su nombre(s), dirección(es) y números de teléfono. Nombre Dirección Número de Teléfono La solución prevista: Indique lo que usted cree que se puede y se debe hacer para resolver el problema. Sea lo más específico posible. Certifico que esta información es correcta según mi leal saber y entender. Firma del Denunciante Fecha Documento recibido por Fecha Oficial de la investigación Fecha JICK-E1 Revised: Appendix VI-24 p. 5

6 Case 4:74-cv DCB Document Filed 10/01/14 Page 164 of 229 Student Violence, Bullying, Intimidation, Harassment Complaint Form - Spanish REPORTE DEL DIRECTOR (que se enviará al director del sitio y a Charlotte Brown del Departamento de Equidad Estudiantil) Conclusiones: Determinación: Acción Correctiva: JICK-E1 Revised: Appendix VI-24 p. 6

TITLE VI COMPLAINT FORM

TITLE VI COMPLAINT FORM TITLE VI COMPLAINT FORM Before filling out this form, please read the Arcata and Mad River Transit System Title VI Complaint Procedures located on our website or by visiting our office. The following information

Más detalles

OJO: Todos los formularios deberán llenarse en inglés. De lo contrario, no se le permitirá presentar sus documentos ante la Secretaría del Tribunal.

OJO: Todos los formularios deberán llenarse en inglés. De lo contrario, no se le permitirá presentar sus documentos ante la Secretaría del Tribunal. OJO: Todos los formularios deberán llenarse en inglés. De lo contrario, no se le permitirá presentar sus documentos ante la Secretaría del Tribunal. For Clerk s Use Only (Para uso de la Secretaria solamente)

Más detalles

TITLE VI COMPLAINT FORM

TITLE VI COMPLAINT FORM [CITY SEAL/EMBLEM] The Capital City of the Palm Beaches TITLE VI COMPLAINT FORM Title VI of the 1964 Civil Rights Act requires that "No person in the United States shall, on the ground of race, color or

Más detalles

Title VI Complaint Procedures

Title VI Complaint Procedures Title VI Complaint Procedures As a recipient of federal dollars, HELP of Ojai, Inc. is required to comply with Title VI of the Civil Rights Act of 1964 and ensure that services and benefits are provided

Más detalles

PRINTING INSTRUCTIONS

PRINTING INSTRUCTIONS PRINTING INSTRUCTIONS 1. Print the Petition form on 8½ X 11inch paper. 2. The second page (instructions for circulator) must be copied on the reverse side of the petition Instructions to print the PDF

Más detalles

Migrant. Learners Today LEADERS Tomorrow!

Migrant. Learners Today LEADERS Tomorrow! Migrant Learners Today LEADERS Tomorrow! 2014 Migrant Summer Program Language Enrichment for English Language Learners Through Science Themes Students will enhance English language acquisition through

Más detalles

Becoming Independent Title VI Program

Becoming Independent Title VI Program Title VI Complaint Procedures As a recipient of federal fund, Becoming Independent is required to comply with Title VI of the Civil Rights Act of 1964 and ensure that program and services are provided

Más detalles

Lump Sum Final Check Contribution to Deferred Compensation

Lump Sum Final Check Contribution to Deferred Compensation Memo To: ERF Members The Employees Retirement Fund has been asked by Deferred Compensation to provide everyone that has signed up to retire with the attached information. Please read the information from

Más detalles

Title VI Complaint Form Horizon Cross Cultural Center (HORIZON) (formerly St. Anselm s Cross-Cultural Community Center) Office of Civil Rights

Title VI Complaint Form Horizon Cross Cultural Center (HORIZON) (formerly St. Anselm s Cross-Cultural Community Center) Office of Civil Rights Title VI Complaint Form Horizon Cross Cultural Center (HORIZON) (formerly St. Anselm s Cross-Cultural Community Center) Title VI of the Civil Rights Act of 1964 provides that no person in the United States

Más detalles

Registro de Semilla y Material de Plantación

Registro de Semilla y Material de Plantación Registro de Semilla y Material de Plantación Este registro es para documentar la semilla y material de plantación que usa, y su estatus. Mantenga las facturas y otra documentación pertinente con sus registros.

Más detalles

Vermont Mini-Lessons: Leaving A Voicemail

Vermont Mini-Lessons: Leaving A Voicemail Vermont Mini-Lessons: Leaving A Voicemail Leaving a Voice Mail Message Learning Objective 1) When to leave a message 2) How to leave a message Materials: 1) Voice Mail Template blanks & samples 2) Phone

Más detalles

Setting Up an Apple ID for your Student

Setting Up an Apple ID for your Student Setting Up an Apple ID for your Student You will receive an email from Apple with the subject heading of AppleID for Students Parent/Guardian Information Open the email. Look for two important items in

Más detalles

Goodwill Serving the People of Southern Los Angeles County. Title VI Notice to the Public

Goodwill Serving the People of Southern Los Angeles County. Title VI Notice to the Public Title VI Notice to the Public Notifying the Public of Rights Under Title VI (Goodwill SOLAC) operates its programs and services without regard to race, color, and national origin in accordance with Title

Más detalles

PROCEDIMIENTOS: QUÉ HACER CON EL PEDIMENTO UNA VEZ QUE SE HA COMPLETADO

PROCEDIMIENTOS: QUÉ HACER CON EL PEDIMENTO UNA VEZ QUE SE HA COMPLETADO CENTRO DE AUTOSERVICIO PROCEDIMIENTOS: QUÉ HACER CON EL PEDIMENTO UNA VEZ QUE SE HA COMPLETADO PASO 1: COPIAS Y SOBRES. Haga tres (3) copias de las páginas siguientes del pedimento; Haga dos (2) copias

Más detalles

News Flash! Primary & Specialty Care Providers. Sharp Health Plan. Date: February 17, 2012. Subject: Member Grievance Forms

News Flash! Primary & Specialty Care Providers. Sharp Health Plan. Date: February 17, 2012. Subject: Member Grievance Forms I M P O R T A N T News Flash! A FAX Publication for Providers of Sharp Health Plan To: From: Primary & Specialty Care Providers Sharp Health Plan Date: February 17, 2012 Subject: Member Grievance Forms

Más detalles

UNIVERSIDAD GABRIELA MISTRAL Departamento de Relaciones Internacionales. Formulario de Postulación (Aplication For Admission/Exchange Student)

UNIVERSIDAD GABRIELA MISTRAL Departamento de Relaciones Internacionales. Formulario de Postulación (Aplication For Admission/Exchange Student) Personal Data Nombre/First Name Apellidos/Last Name Dirección/Permanent Address Numbers/Street Ciudad City/Province País Country Teléfono Local Phone Number (with area codes) E-mail Fecha de Nacimiento

Más detalles

We appreciate your time and patience as we work towards resolving this problem.

We appreciate your time and patience as we work towards resolving this problem. Please download the attached Barking Dog Incident Log Take the time to fill out the log completely, When at least seven (7) days of habitual barking are documented, the log should be returned to Animal

Más detalles

Title VI Complaint Procedures

Title VI Complaint Procedures Title VI Complaint Procedures As a recipient of federal fund, Self-Help for the Elderly is required to comply with Title VI of the Civil Rights Act of 1964 and ensure that program and services are provided

Más detalles

Lone Star Legal Aid Procedure for Applicants to Complain About the Denial of Legal Assistance

Lone Star Legal Aid Procedure for Applicants to Complain About the Denial of Legal Assistance Lone Star Legal Aid Procedure for Applicants to Complain About the Denial of Legal Assistance Procedimiento de Queja para Solicitantes Sobre la Negación de Asistencia Legal 1. Notificación sobre el Derecho

Más detalles

OJO: Todos los formularios deberán completarse en inglés. De lo contrario, no se le permitirá presentar sus documentos en la Secretaría del Tribunal.

OJO: Todos los formularios deberán completarse en inglés. De lo contrario, no se le permitirá presentar sus documentos en la Secretaría del Tribunal. OJO: Todos los formularios deberán completarse en inglés. De lo contrario, no se le permitirá presentar sus documentos en la Secretaría del Tribunal. Person Filing: (Nombre de persona:) Address (if not

Más detalles

INFORMACIÓN PARA ABRIR UNA GUARDERÍA DE NIÑOS PARA FAMILIAS O GRUPOS EN LA CIUDAD DE ALLENTOWN

INFORMACIÓN PARA ABRIR UNA GUARDERÍA DE NIÑOS PARA FAMILIAS O GRUPOS EN LA CIUDAD DE ALLENTOWN INFORMACIÓN PARA ABRIR UNA GUARDERÍA DE NIÑOS PARA FAMILIAS O GRUPOS EN LA CIUDAD DE ALLENTOWN Informacion importante de saber: Una guarderia de niños para familias consite de un niño hasta 6 niños. Una

Más detalles

Voter Information Guide and Sample Ballot

Voter Information Guide and Sample Ballot Voter Information Guide and Sample Ballot Special Election San Bernardino Mountains Community Hospital District Tuesday, June 4, 2013 Elections Office of the Registrar of Voters 777 East Rialto Ave. San

Más detalles

As the 2013-14 school year comes to a close, Camden City School District is excited to get summer programming underway!

As the 2013-14 school year comes to a close, Camden City School District is excited to get summer programming underway! June 2014 Dear Parents and Guardians: As the 2013-14 school year comes to a close, Camden City School District is excited to get summer programming underway! The District Summer School Program will operate

Más detalles

MANUAL EASYCHAIR. A) Ingresar su nombre de usuario y password, si ya tiene una cuenta registrada Ó

MANUAL EASYCHAIR. A) Ingresar su nombre de usuario y password, si ya tiene una cuenta registrada Ó MANUAL EASYCHAIR La URL para enviar su propuesta a la convocatoria es: https://easychair.org/conferences/?conf=genconciencia2015 Donde aparece la siguiente pantalla: Se encuentran dos opciones: A) Ingresar

Más detalles

Creating your Single Sign-On Account for the PowerSchool Parent Portal

Creating your Single Sign-On Account for the PowerSchool Parent Portal Creating your Single Sign-On Account for the PowerSchool Parent Portal Welcome to the Parent Single Sign-On. What does that mean? Parent Single Sign-On offers a number of benefits, including access to

Más detalles

Becoming Independent Title VI Program

Becoming Independent Title VI Program Title VI Notice to the Public operate its programs and services without regard to race, color, and national origin in accordance with Title VI of the Civil Rights Act. Any person who believes she or he

Más detalles

Spanish Version provided Below

Spanish Version provided Below Spanish Version provided Below Greater Waltown United Holy Church s Summer Reading and Math Program 706 Belvin Avenue Durham, N. C. 27712 (919) 220-7087 May 3, 2015 Dear Parent/Guardian: Summer can be

Más detalles

Recomendación para el Programa de Servicios Académicos Avanzados

Recomendación para el Programa de Servicios Académicos Avanzados Recomendación para el Programa de Servicios Académicos Avanzados Este formulario debe ser devuelto antes de: 11 de diciembre de 2015 PERMISO de los padres y formulario de recomendación Fecha de hoy Nombre

Más detalles

Exceptional Children s Foundation Title VI Notice to the Public

Exceptional Children s Foundation Title VI Notice to the Public Title VI Notice to the Public Notifying the Public of Rights Under Title VI Exceptional Children s Foundation The Exceptional Children s Foundation (ECF) operates its programs and services without regard

Más detalles

Daly Elementary. Family Back to School Questionnaire

Daly Elementary. Family Back to School Questionnaire Daly Elementary Family Back to School Questionnaire Dear Parent(s)/Guardian(s), As I stated in the welcome letter you received before the beginning of the school year, I would be sending a questionnaire

Más detalles

LOS ANGELES UNIFIED SCHOOL DISTRICT OFFICE OF PERMITS AND STUDENT TRANSERS

LOS ANGELES UNIFIED SCHOOL DISTRICT OFFICE OF PERMITS AND STUDENT TRANSERS INTER-DISTRICT PERMIT APPEALS If your inter-district permit application has been denied cancelled, or revoked, you may appeal the decision if you believe that an exception to district policy is warranted

Más detalles

Al responder haga referencia a: Ref.: NT-N1-17 EMX0435 30 de abril de 2015

Al responder haga referencia a: Ref.: NT-N1-17 EMX0435 30 de abril de 2015 Al responder haga referencia a: Ref.: NT-N1-17 EMX0435 30 de abril de 2015 Para: Estados y Organizaciones Internacionales Asunto: Invitación a la Sexta Cumbre Panamericana de Seguridad Operacional de la

Más detalles

APPLICATION FORM FOR INTERNATIONAL STUDENTS. 3. Número de Pasaporte / Passport Number: 4. Dirección de Residencia / Present Address:

APPLICATION FORM FOR INTERNATIONAL STUDENTS. 3. Número de Pasaporte / Passport Number: 4. Dirección de Residencia / Present Address: . Nombres / Name: Photo. Apellidos / Last Name:. Número de Pasaporte / Passport Number:. Dirección de Residencia / Present Address:. Teléfono: (incluya prefijo del país y ciudad) Phone number including

Más detalles

Promotion of electronic resources by consortia and libraries

Promotion of electronic resources by consortia and libraries Promotion of electronic resources by consortia and libraries Report template 2014 competition Applicant details Country Consortium/Institutio n name Address Applicant s name Nicaragua Universidad Nacional

Más detalles

The Home Language Survey (HLS) and Identification of Students

The Home Language Survey (HLS) and Identification of Students The Home Language Survey (HLS) and Identification of Students The Home Language Survey (HLS) is the document used to determine a student that speaks a language other than English. Identification of a language

Más detalles

IMPORTANT INFORMATION

IMPORTANT INFORMATION Checklist IMPORTANT INFORMATION and REQUIRED FORMS Parents should review and be familiar with the following information. The relevant forms must be printed, completed and returned to the school by Friday,

Más detalles

My Home Access Center. Mi Centro de Acceso del Hogar

My Home Access Center. Mi Centro de Acceso del Hogar My Home Access Center Web Address: http://d99homeaccess.spihost.com/ My Username: My Password: (case-sensitive) Keep this information in a safe place. To register a username or password, or to change your

Más detalles

PRUEBA DE INGLÉS SECUNDARIA

PRUEBA DE INGLÉS SECUNDARIA Dirección General de Ordenación Académica e Innovación Educativa PRUEBA DE INGLÉS SECUNDARIA EXPRESIÓN ORAL AUTOAPLICACIÓN EVALUACIÓN DIAGNÓSTICA SECUNDARIA 2007 Servicio de Evaluación y Calidad Educativa

Más detalles

Certified translation Traducción certificada. Qué es una Declaración de Impacto de la Víctima?

Certified translation Traducción certificada. Qué es una Declaración de Impacto de la Víctima? Translated from English to Spanish Traducido del inglés al español Certified translation Traducción certificada Victim Impact Statements "Declaraciones de Impacto de la Víctima" June 2014 Junio 2014 Qué

Más detalles

School Preference through the Infinite Campus Parent Portal

School Preference through the Infinite Campus Parent Portal School Preference through the Infinite Campus Parent Portal Welcome New and Returning Families! Enrollment for new families or families returning to RUSD after being gone longer than one year is easy.

Más detalles

Mi ciudad interesante

Mi ciudad interesante Mi ciudad interesante A WebQuest for 5th Grade Spanish Designed by Jacob Vuiller jvuiller@vt.edu Introducción Tarea Proceso Evaluación Conclusión Créditos Introducción Bienvenidos! Eres alcalde de una

Más detalles

www.deltadentalins.com/language_survey.html

www.deltadentalins.com/language_survey.html Survey Code: Survey 1 February 6, 2008 Dear Delta Dental Enrollee: Recent changes in California law will require that all health care plans provide language assistance to their plan enrollees beginning

Más detalles

LOS ANGELES UNIFIED SCHOOL DISTRICT STUDENT EMERGENCY INFORMATION FORM Parent Information: Please fill out completely and sign where indicated. In a major emergency, it is school district policy to retain

Más detalles

Student and Adult Release Forms

Student and Adult Release Forms Student and Adult Release Forms The following sample release forms are provided along with an explanation of the forms and your responsibility. For Tasks 3 and 4, your response will be based, in part,

Más detalles

El Estado de Nevada le prestará ayuda con el costo de medicamentos recetados si califica:

El Estado de Nevada le prestará ayuda con el costo de medicamentos recetados si califica: Necesita ayuda para pagar sus medicamentos recetados? SeniorRx puede ser la solución! El Estado de Nevada le prestará ayuda con el costo de medicamentos recetados si califica: - Edad 62 años o más -Residentes

Más detalles

Contenido REQUISITOS PARA OFERTA PROVENIENTE DEL EXTERIOR... 1 REQUIREMENTS FOR INTERNATIONAL PURCHASES... 4

Contenido REQUISITOS PARA OFERTA PROVENIENTE DEL EXTERIOR... 1 REQUIREMENTS FOR INTERNATIONAL PURCHASES... 4 Contenido REQUISITOS PARA OFERTA PROVENIENTE DEL EXTERIOR... 1 REQUIREMENTS FOR INTERNATIONAL PURCHASES... 4 REQUISITOS PARA OFERTA PROVENIENTE DEL EXTERIOR La Pro forma inicial que proviene del proveedor

Más detalles

INSTRUCTIONS FOR COMPLETING THE UA_SGE_FT_03_FI_IE FORM REGARDING NATURAL PERSONS DATA FOR THE UA SUPPLIERS DATABASE

INSTRUCTIONS FOR COMPLETING THE UA_SGE_FT_03_FI_IE FORM REGARDING NATURAL PERSONS DATA FOR THE UA SUPPLIERS DATABASE INSTRUCTIONS FOR COMPLETING THE UA_SGE_FT_03_FI_IE FORM REGARDING NATURAL PERSONS DATA FOR THE UA SUPPLIERS DATABASE This form is for use by both Spanish and foreign natural persons. Due to the new requirements

Más detalles

El límite mínimo para las cuentas comerciales grandes es de $2,000/mes por el uso del servicio.

El límite mínimo para las cuentas comerciales grandes es de $2,000/mes por el uso del servicio. ONNETIUT OBERTURA DEL FORMULARIO DE FAX PARA: XOOM Energy lientes omerciales No. FAX: 866.452.0053 FEHA: NOMBRE DE EMPRESARIO INDEPENDIENTE: # IDENTIFIAIÓN DE NEGOIO: ORREO ELETRÓNIO: # DE PÁGINAS: TELÉFONO:

Más detalles

AGENCY POLICY: REVIEW OF NOTICE OF PRIVACY PRACTICES

AGENCY POLICY: REVIEW OF NOTICE OF PRIVACY PRACTICES AGENCY POLICY: REVIEW OF NOTICE OF PRIVACY PRACTICES SCOPE OF POLICY This policy applies to all agency staff members. Agency staff members include all employees, trainees, volunteers, consultants, students,

Más detalles

What is family health history?

What is family health history? Family Health History Project Pre-Survey What is family health history? Family health history is information about diseases that run in your family, as well as the eating habits, activities, and environments

Más detalles

I understand that I must request that this waiver be reconsidered annually, each school year. Parent/Guardian Signature: Date:

I understand that I must request that this waiver be reconsidered annually, each school year. Parent/Guardian Signature: Date: Page 1 of 7 PARENTAL EXCEPTION WAIVER EDUCATION CODE 311(a): Children who know English (Exhibit 1) Name: School: Grade: Date of Birth: Language Designation: My child possesses good English language skills

Más detalles

Si tiene cualquier pregunta llame a su trabajadora de CCAP al número de teléfono indicado abajo. Boulder County Child Care Assistance Program

Si tiene cualquier pregunta llame a su trabajadora de CCAP al número de teléfono indicado abajo. Boulder County Child Care Assistance Program Child Care Assistance Program Búsqueda de Trabajo Usted ha pedido cuidado para sus niños mientras busca trabajo a través del programa de CCAP. Este programa ofrece un total de 30 días mientras busca trabajo.

Más detalles

Portal para Padres CPS - Parent Portal. Walter L. Newberry Math & Science Academy Linda Foley-Acevedo, Principal Ed Collins, Asst.

Portal para Padres CPS - Parent Portal. Walter L. Newberry Math & Science Academy Linda Foley-Acevedo, Principal Ed Collins, Asst. Portal para Padres CPS - Parent Portal Walter L. Newberry Math & Science Academy Linda Foley-Acevedo, Principal Ed Collins, Asst. Principal (773) 534-8000 Formando su cuenta - Setting up your account Oprima

Más detalles

Solicitud para Licencia de matrimonio (Marriage License Request)

Solicitud para Licencia de matrimonio (Marriage License Request) Solicitud para Licencia de matrimonio (Marriage License Request) Este documento contiene una traducción de la solicitud en línea para obtener una Licencia o permiso de matrimonio (o Marriage License, en

Más detalles

2015 16 Student Eligibility Verification Advanced Placement/International Baccalaureate Test Fee Program

2015 16 Student Eligibility Verification Advanced Placement/International Baccalaureate Test Fee Program 2015 16 Student Eligibility Verification Advanced Placement (AP) and/or International Baccalaureate (IB) Exams AP Exam IB Exam AP and IB Exams I. Student Information Last Name First Name MI Grade High

Más detalles

Formulario de Postulación Universidad Católica Santo Toribio De Mogrovejo Estudiante de Intercambio Application Form / Exchange Student

Formulario de Postulación Universidad Católica Santo Toribio De Mogrovejo Estudiante de Intercambio Application Form / Exchange Student Formulario de Postulación Universidad Católica Santo Toribio De Mogrovejo Estudiante de Intercambio Application Form / Exchange Student Información Personal Personal Information: Nombre FIrst Name Apellido

Más detalles

Child Care Assistance Program Búsqueda de Trabajo

Child Care Assistance Program Búsqueda de Trabajo Child Care Assistance Program Búsqueda de Trabajo Usted ha pedido cuidado para sus niños mientras busca trabajo a través del programa de CCAP. Este programa ofrece un total de 30 días mientras busca trabajo.

Más detalles

CUESTIONARIO DISEÑADO PARA EVALUAR EL PRODUCTO DESCUBRE LAS PALMAS DE GC! QUE SERÁ ADMINISTRADO A TRAVÉS DE LA WEB CREADA PARA EL PRODUCTO.

CUESTIONARIO DISEÑADO PARA EVALUAR EL PRODUCTO DESCUBRE LAS PALMAS DE GC! QUE SERÁ ADMINISTRADO A TRAVÉS DE LA WEB CREADA PARA EL PRODUCTO. ANEXO E. CUESTIONARIO DISEÑADO PARA EVALUAR EL PRODUCTO DESCUBRE LAS PALMAS DE GC! QUE SERÁ ADMINISTRADO A TRAVÉS DE LA WEB CREADA PARA EL PRODUCTO. CUESTIONARIO: El proyecto Descubre Las Palmas de GC!

Más detalles

HABERSHAM COUNTY SCHOOLS LAS ESCUELAS DEL CONDADO DE HABERSHAM ENROLLMENT/STUDENT INFORMATION FORM FORMA DE MATRICULACION

HABERSHAM COUNTY SCHOOLS LAS ESCUELAS DEL CONDADO DE HABERSHAM ENROLLMENT/STUDENT INFORMATION FORM FORMA DE MATRICULACION HABERSHAM COUNTY SCHOOLS LAS ESCUELAS DEL CONDADO DE HABERSHAM ENROLLMENT/STUDENT INFORMATION FORM FORMA DE MATRICULACION CHILD LIVES IN SCHOOL DISTRICT (PLEASE GIVE NAME OF ELEMENTARY SCHOOL) (distrito

Más detalles

For more information regarding these forms please go to the Texas Department of Insurance website http://www.tdi.state.tx.us/forms/form20employer.

For more information regarding these forms please go to the Texas Department of Insurance website http://www.tdi.state.tx.us/forms/form20employer. CAPROCK Claims Management, LLC ROCK SOLID PERFORMANCE AND RESULTS PO Box 743427 Dallas, TX 75374 (888) 812-3577 Fax (972) 934-3091 IMPORTANT NOTICE FOR REQUIRED FILING FORMS DWC FORM-5 & DWC FORM-7 Caprock

Más detalles

Welcome to the CU at School Savings Program!

Welcome to the CU at School Savings Program! Welcome to the CU at School Savings Program! Thank you for your interest in Yolo Federal Credit Union s CU at School savings program. This packet of information has everything you need to sign your child

Más detalles

MISSISSIPPI EMPLOYEES

MISSISSIPPI EMPLOYEES 1961 Diamond Springs Road Virginia Beach, VA 23455 Phone (757) 460-6308 Fax (757) 457-9345 MISSISSIPPI EMPLOYEES MANCON Employees, Included in this packet is the following information: 1. Job Insurance

Más detalles

Identity and Statement of Educational Purpose (To Be Signed in the Presence of a Notary)

Identity and Statement of Educational Purpose (To Be Signed in the Presence of a Notary) Identity and Statement of Educational Purpose (To Be Signed in the Presence of a Notary) If the student is unable to appear in person at (Name of Postsecondary Educational Institution) to verify his or

Más detalles

Solicitud de Intercambio Academico por Convenio Bilateral UPAEP para alumnos extranjeros

Solicitud de Intercambio Academico por Convenio Bilateral UPAEP para alumnos extranjeros Solicitud de Intercambio Academico por Convenio Bilateral UPAEP para alumnos extranjeros INFORMACION PERSONAL Favor de utilizar letra de molde Carrera: Semestre: Promedio: Fotografia Nombre completo: Ap.

Más detalles

ORANGE TOWNSHIP PUBLIC SCHOOLS

ORANGE TOWNSHIP PUBLIC SCHOOLS ORANGE TOWNSHIP PUBLIC SCHOOLS ACOSO, INTIMIDACION y HOSTIGAMIENTO Manual para Padres y Alumnos PAMELA R. HORN, HIB Coordinator Orange Township Public Schools Administration Building 251 Lincoln Avenue

Más detalles

COMMUNITY COLLEGE INITIATIVE PROGRAM STUDENT APPLICATION

COMMUNITY COLLEGE INITIATIVE PROGRAM STUDENT APPLICATION COMMUNITY COLLEGE INITIATIVE PROGRAM STUDENT APPLICATION DEADLINE: 8 November 2010 before 11a.m. IMPORTANT: Do not leave blank spaces. Please complete your application in English. Personal Information

Más detalles

Formulario de Postulación Estudiante de Intercambio Application Form / Exchange Student

Formulario de Postulación Estudiante de Intercambio Application Form / Exchange Student Formulario de Postulación Estudiante de Intercambio Application Form / Exchange Student Información Personal Personal Information Nombres First Name Apellidos Last Name Dirección permanente Permanent Address

Más detalles

Nombre Clase Fecha. committee has asked a volunteer to check off the participants as they arrive.

Nombre Clase Fecha. committee has asked a volunteer to check off the participants as they arrive. SITUATION You are participating in an International Student Forum. The organizing committee has asked a volunteer to check off the participants as they arrive. TASK As the volunteer, greet the participants

Más detalles

Cal Grant GPA Electronic Submission and Opt-out Notification As of 10.13.15

Cal Grant GPA Electronic Submission and Opt-out Notification As of 10.13.15 12338 McCourtney Road Grass Valley, CA 95949 Phone: 530-272-4008 Fax: 530-272-4009 www.johnmuircs.com Cal Grant GPA Electronic Submission and Opt-out Notification As of 10.13.15 Assembly Bill 2160, commonly

Más detalles

Organización de Planificación Metropolitana de Broward (Broward Metropolitan Planning Organization)

Organización de Planificación Metropolitana de Broward (Broward Metropolitan Planning Organization) Organización de Planificación Metropolitana de Broward (Broward Metropolitan Planning Organization) PROCEDIMIENTOS DE DENUNCIA DE DISCRIMINACIÓN - TÍTULO VI La Organización de Planificación Metropolitana

Más detalles

Workers Compensation Non-Subscriber Form

Workers Compensation Non-Subscriber Form Workers Compensation Non-Subscriber Form Texas is unique in one very important respect: It s the only state in which employers have the choice to carry workers compensation insurance or not. There are

Más detalles

Adult Application 18 and over ONLY ******************************** Aplicación de Adultos Solo para mayores de 18 años

Adult Application 18 and over ONLY ******************************** Aplicación de Adultos Solo para mayores de 18 años Adult Application 18 and over ONLY ******************************** Aplicación de Adultos Solo para mayores de 18 años FREE GRATIS Beacon Programs Adult Enrollment Form Beacon PROGRAMS Participant Information

Más detalles

Adobe Acrobat Reader X: Manual to Verify the Digital Certification of a Document

Adobe Acrobat Reader X: Manual to Verify the Digital Certification of a Document dobe crobat Reader X: Manual de verificación de Certificación Digital de un documento dobe crobat Reader X: Manual to Verify the Digital Certification of a Document support@bioesign.com Desarrollado por:

Más detalles

Q. What is the 1095-B form and why does it matter to me?

Q. What is the 1095-B form and why does it matter to me? FAQ This tax season, certain Medicaid members will receive Form 1095-B from the Georgia Medicaid/ PeachCare for Kids program. Select members who receive their healthcare coverage through Fee-for-Service

Más detalles

DEPARTAMENTO ESTATAL DE SERVICIOS DE SALUD DE TEXAS

DEPARTAMENTO ESTATAL DE SERVICIOS DE SALUD DE TEXAS DEPARTAMENTO ESTATAL DE SERVICIOS DE SALUD DE TEXAS DAVID L. LAKEY, M.D. DIRECTOR P.O. Box 149347 Austin, Texas 78714-9347 1-888-963-7111 TTY (teletipo): 1-800-735-2989 www.dshs.state.tx.us 1 de marzo,

Más detalles

INSTRUCTIONS FOR COMPLETING THE UA-SGE-FT-05-FI-IE FORM REGARDING NATURAL PERSONS DATA FOR THE UA SUPPLIERS DATABASE

INSTRUCTIONS FOR COMPLETING THE UA-SGE-FT-05-FI-IE FORM REGARDING NATURAL PERSONS DATA FOR THE UA SUPPLIERS DATABASE INSTRUCTIONS FOR COMPLETING THE UA-SGE-FT-05-FI-IE FORM REGARDING NATURAL PERSONS DATA FOR THE UA SUPPLIERS DATABASE This form is for use by both Spanish and foreign natural persons. Due to the new requirements

Más detalles

Northwestern University, Feinberg School of Medicine

Northwestern University, Feinberg School of Medicine Improving Rates of Repeat Colorectal Cancer Screening Appendix Northwestern University, Feinberg School of Medicine Contents Patient Letter Included with Mailed FIT... 3 Automated Phone Call... 4 Automated

Más detalles

HOMEWORK HELP PROGRAM STUDENT REQUIREMENTS STUDENT GUIDELINES

HOMEWORK HELP PROGRAM STUDENT REQUIREMENTS STUDENT GUIDELINES HOMEWORK HELP PROGRAM This program is a cooperative learning experience shared between high school and elementary school students in the East Ramapo Central School District. It is designed to match Elementary

Más detalles

Sample Customer Rights and Complaint Resolution Procedure and Customer Complaint Form

Sample Customer Rights and Complaint Resolution Procedure and Customer Complaint Form Participating in workforce services administered by the Texas Workforce Commission (Commission) or Workforce Development Board (Board) grants you the right to file a complaint regarding your workforce

Más detalles

HEAD START MEDICATION ADMINISTRATION

HEAD START MEDICATION ADMINISTRATION HEAD START MEDICATION ADMINISTRATION Dear Parents/Guardians: It is the policy of Head Start to cooperate with each Head Start child's parent/guardian and his/her physician by administering and providing

Más detalles

CARTA INFORMACIONAL AL LITIGANTE LINEA DE AYUDA HOJA DE CALCULOS DE MANUTENCION DE MENORES

CARTA INFORMACIONAL AL LITIGANTE LINEA DE AYUDA HOJA DE CALCULOS DE MANUTENCION DE MENORES CARTA INFORMACIONAL AL LITIGANTE LINEA DE AYUDA HOJA DE CALCULOS DE MANUTENCION DE MENORES CHILD SUPPORT WORKSHEET HELPLINE INFORMATIONAL LETTER TO LITIGANT Estimado Pro Se Litigante, Dear Pro Se Litigant,

Más detalles

Southern California Lumber Industry Retirement Fund

Southern California Lumber Industry Retirement Fund Southern California Lumber Industry Retirement Fund Established Jointly by Employers and Local Unions Telephone (562) 463-5080 (800) 824-4427 Facsimile (562) 463-5894 www.lumberfund.org January 9, 2015

Más detalles

Alcance: Todas las titulaciones que se imparten en la Escuela Universitaria Cardenal Cisneros

Alcance: Todas las titulaciones que se imparten en la Escuela Universitaria Cardenal Cisneros IT 05 Gestión del Programa Erasmus TÍTULO: Gestión del Programa Erasmus CÓDIGO: IT 05 Alcance: Todas las titulaciones que se imparten en la Escuela Universitaria Cardenal Cisneros Proceso: 1. Presentación

Más detalles

DANCE, CANTE, GUITAR AND RITMO&COMPÁS

DANCE, CANTE, GUITAR AND RITMO&COMPÁS La Guarida del Ángel and Faro Producciones with Centro Andaluz de Flamenco PROGRAMME OF THE COURSES, CANTE, GUITAR AND RITMO&COMPÁS From 22 February to 4 March : Farrucos Family (La Farruca, Farru and

Más detalles

Al responder haga referencia a: Ref.: NT-N1-17.2 EMX0669 29 de junio de 2015

Al responder haga referencia a: Ref.: NT-N1-17.2 EMX0669 29 de junio de 2015 Al responder haga referencia a: Ref.: NT-N1-17.2 EMX0669 29 de junio de 2015 Para: Estados y Organizaciones Internacionales Asunto: Invitación la Décima Reunión del Equipo de Análisis de Información (IAT/10)

Más detalles

NOTICE OF ERRATA MEDICARE Y USTED 2006 October 18, 2006

NOTICE OF ERRATA MEDICARE Y USTED 2006 October 18, 2006 CONTENTS 1) Notice of Errata 10/18/05 2) General Message for Partners 3) Action Plan for Spanish Handbook Error 4) Language for CMS Publication Mailing List 1 Where Does the Error Occur? NOTICE OF ERRATA

Más detalles

OSCILLATION 512 (LM 3R)

OSCILLATION 512 (LM 3R) Application Note The following application note allows to locate the LM series devices (LM3E, LM3R, LM4 and LM5) within network and check its connection information: Name, MAC, dynamic IP address and static

Más detalles

RENT CONTROL BOARD OF THE TOWN OF WEST NEW YORK, N.J. 428-60 TH STREET WEST NEW YORK, N.J. 07093-2231 (201) 295-5290/91/92

RENT CONTROL BOARD OF THE TOWN OF WEST NEW YORK, N.J. 428-60 TH STREET WEST NEW YORK, N.J. 07093-2231 (201) 295-5290/91/92 FELIX E. ROQUE, MD MAYOR DEPT. OF PUBLIC AFFAIRS RENT CONTROL BOARD RENTAL AGREEMENT APPLICATION NAME OF ADDRESS OF LANDLORD: PROPERTY ADDRESS: APARTMENT #: 3 COPIES (1) Original rental agreement signed

Más detalles

IMMIGRATION Canada. Temporary Resident Visa. Mexico City Visa Office Instructions. Table of Contents IMM 5878 E (10-2015)

IMMIGRATION Canada. Temporary Resident Visa. Mexico City Visa Office Instructions. Table of Contents IMM 5878 E (10-2015) IMMIGRATION Canada Table of Contents Document Checklist Temporary resident visa (available in Spanish) Emergency Processing Request Form Temporary Resident Visa Mexico City Visa Office Instructions This

Más detalles

Formulario de Solicitud

Formulario de Solicitud Health Net Medicare Advantage Plans Inscripción Breve en Medicare Advantage 2016 Formulario de Solicitud Nombre del plan en el que se inscribirá: Health Net Healthy Heart (HMO) (incluye cobertura de medicamentos

Más detalles

EXPAND HORIZONS. When you gaze out at the horizon, what do you see? You see where one vista ends and another one begins. You think POSSIBILITIES

EXPAND HORIZONS. When you gaze out at the horizon, what do you see? You see where one vista ends and another one begins. You think POSSIBILITIES EXPANDING HORIZONS EXPAND HORIZONS IS WHAT PAUL CUFFEE SCHOOL DOES. When you gaze out at the horizon, what do you see? You see where one vista ends and another one begins. You think POSSIBILITIES Selected

Más detalles

Application to become an ACE Volunteer HEI Summer 2015

Application to become an ACE Volunteer HEI Summer 2015 Application to become an ACE Volunteer HEI Summer 2015 (ACE: Academic Counselor of Enrichment / HEI: Hawthorn Enrichment Institute) Become an ACE (Academic Counselor of Enrichment) for HEI. ACE counselors

Más detalles

2014 15 Student Eligibility Verification Advanced Placement/International Baccalaureate Test Fee Program

2014 15 Student Eligibility Verification Advanced Placement/International Baccalaureate Test Fee Program 2014 15 Student Eligibility Verification Advanced Placement (AP) and/or International Baccalaureate (IB) Exams þ AP Exam IB Exam AP and IB Exams I. Student Information Last Name First Name MI Grade High

Más detalles

(MUST BE COMPLETED IN ENGLISH) DATE: June 15-22, 2014 EVENT: PUERTO RICO TRADE MISSION TO THE CARIBBEAN 2014 COMPANY NAME: Physical Address:

(MUST BE COMPLETED IN ENGLISH) DATE: June 15-22, 2014 EVENT: PUERTO RICO TRADE MISSION TO THE CARIBBEAN 2014 COMPANY NAME: Physical Address: DATE: June 15-22, 2014 EVENT: PUERTO RICO TRADE MISSION TO THE CARIBBEAN 2014 COMPANY NAME: Physical Address: Postal Address: Name of the President or CEO: Web Page: First Participant: Telephone(s): E-mail:

Más detalles

TIPO DE CAMBIO AL CIERRE DE 2011 2 de enero de 2012 CLOSING EXCHANGE RATES AT YEAR END 2011 January 2, 2012. January 2, 2012 2 de enero de 2012

TIPO DE CAMBIO AL CIERRE DE 2011 2 de enero de 2012 CLOSING EXCHANGE RATES AT YEAR END 2011 January 2, 2012. January 2, 2012 2 de enero de 2012 CLOSING EXCHANGE RATES AT YEAR END 2011 TIPOS DE CAMBIO AL CIERRE DE 2011 January 2, 2012 2 de enero de 2012 This document is prepared by Acus Consulting and Alberto Calva. This document is available at

Más detalles

FORMULARIO DE EVALUACIÓN DEL PROFESOR

FORMULARIO DE EVALUACIÓN DEL PROFESOR FORMULARIO DE EVALUACIÓN DEL PROFESOR Se requiere la autorización de los padres o tutor para obtener de un miembro del colegio actual las informaciones y recomendaciones necesarias para completar este

Más detalles

FAMILY INDEPENDENCE ADMINISTRATION Seth W. Diamond, Executive Deputy Commissioner

FAMILY INDEPENDENCE ADMINISTRATION Seth W. Diamond, Executive Deputy Commissioner FAMILY INDEPENDENCE ADMINISTRATION Seth W. Diamond, Executive Deputy Commissioner James K. Whelan, Deputy Commissioner Policy, Procedures, and Training Lisa C. Fitzpatrick, Assistant Deputy Commissioner

Más detalles

IRS DATA RETRIEVAL NOTIFICATION DEPENDENT STUDENT ESTIMATOR

IRS DATA RETRIEVAL NOTIFICATION DEPENDENT STUDENT ESTIMATOR IRS DATA RETRIEVAL NOTIFICATION DEPENDENT STUDENT ESTIMATOR Subject: Important Updates Needed for Your FAFSA Dear [Applicant], When you completed your 2012-2013 Free Application for Federal Student Aid

Más detalles

Note: The following information is needed to assist in processing your complaint. Name: Address: City/State/Zip Code: Email Address:

Note: The following information is needed to assist in processing your complaint. Name: Address: City/State/Zip Code: Email Address: Title VI Cmplaint Frm Nte: The fllwing infrmatin is needed t assist in prcessing yur cmplaint. A. Cmplainant s infrmatin: Name: Address: City/State/Zip Cde: Telephne Number (Hme): Telephne Number (Wrk):

Más detalles

Living in America Teacher Resource Series Lesson Script. Lección A: Habilidades Telefónicas / Lesson A: Telephone Skills

Living in America Teacher Resource Series Lesson Script. Lección A: Habilidades Telefónicas / Lesson A: Telephone Skills Living in America Teacher Resource Series Lesson Script Uso del Teléfono / Using the Phone Lección A: Habilidades Telefónicas / Lesson A: Telephone Skills En la lección A, practicarás el uso del teléfono

Más detalles