LOS ANGELES UNIFIED SCHOOL DISTRICT Policy Bulletin
|
|
- María Isabel Paz Sevilla
- hace 8 años
- Vistas:
Transcripción
1 TITLE: NUMBER: ISSUER: Child Health and Disability Prevention (CHDP) Program and Blood Lead Testing BUL Michelle King, Senior Deputy Superintendent School Operations, Office of the Superintendent Debra Duardo, Interim Executive Director Student Health and Human Services ROUTING ESC Superintendents Principals School Nurses School Administrative Assistants DATE: January 22, 2013 POLICY: MAJOR CHANGES: Students must present evidence of having received a specified health assessment examination 18 months prior to or within 90 days of enrollment to first grade. This Bulletin replaces BUL Child Health and Disability Prevention (CHDP) Program and Blood Lead Testing issued on October 23, The content has been revised to reflect current examination requirements, new reference contacts, and elimination of the exclusion policy and annual report. GUIDELINES: The following guidelines apply: Legislation establishing the Child Health and Disability Prevention (CHDP) Program was enacted in Basic to the program is the concept that many physical and mental disabilities can be prevented, or their impact lessened, with early recognition and treatment of defects. (See California Administrative Code, Title 17, Sections 6802 et. Seq. and Health and Safety Code, Part 1, Article 3, 4, Section 320 et seq.). The following assessment procedures were established by legislation for entry to first grade: Evaluation of health status consisting of a health, nutritional, and developmental history, physical examination, including height, weight, dental assessment, vision and hearing screening, blood pressure, urine test, anemia test, blood lead screening, mantoux skin test for tuberculosis screening and immunizations, as deemed necessary by the State of California, the Los Angeles County Department of Health Services and the clinician. This type of assessment must be done within 18 months prior to entry into the first grade or within 90 days after admission. In addition to the first grade physical mandate, other eligible students may receive medical treatment, physical examinations and immunizations as stated above. Other assessments appropriate to age and gender may be included. Student Health and Human Services Page 1 of 13 January 22, 2013
2 All health assessments and medical services are provided free of charge to all financially eligible students or those who have Medi-Cal. If the student is not eligible for medical services according to the above categories, the family must obtain medical services and/or the first grade entrance physical through other public/private providers. Eligibility for students without medical insurance is established from the State of California CHDP Eligibility Determination Table that is updated yearly by the State of California. After the school physical has been completed, the parent/guardian will receive a copy of the Confidential Screening/Billing Report - PM 160 (Attachment A), and the results discussed. Any child, upon completion of this examination who has an actual or suspected health condition that is not currently under care, will be referred for diagnostic and treatment services as indicated. If no regular source of care can be identified, the family may be referred to an appropriate public agency or to no less than three sources of care as listed by the CHDP Referral Provider Book. Requirements for School 1. Every public or private school, which has students enrolled in kindergarten and/or first grade shall, at the time of registration, inform parent/guardian of the provisions of the State CHDP Program. This can be done by providing the Los Angeles Unified School District CHDP Program Consent for Health Assessment, Examination and Eligibility Determination and Receipt/Release of Medical Information - Form (Attachment B) and a letter to parent/guardian (Attachment C). If LAUSD personnel performs the exam, the consent form must be retained in the student s health record. 2. Nutrition screening is a required component of a CHDP examination. 3. Each student must present evidence of having received a specified health assessment examination l8 months prior to or within 90 days of enrollment of first grade unless the parent/guardian has signed a Waiver of Health Examination for School Entry - PM 171B (Attachment D). If the parent is having difficulty obtaining the health screening, refer them to the school nurse for assistance. 4. All information and results of the health screening of each student is confidential and part of the student s health record. It cannot be released without the informed consent of the parent/guardian. Proof of Admission to First Grade 1. Proof of Health Examination Completion Parents/guardians must present written proof of a complete health assessment Student Health and Human Services Page 2 of 13 January 22, 2013
3 within 18 months prior to the first day of first grade or within 90 days after entry to first grade. (Date of entry into first grade may vary according to the current school calendar.) This proof may be presented on either: a. CHDP Assessment Confidential Screening/Billing Report Form PM 160 (Attachment A) b. State of California Report of Health Examination for School Entry - PM 171A (Attachment E) or equivalent 2. Waiver of Health Examination Parents/guardians who do not wish to provide evidence of an examination should sign a Waiver of Health Examination for School Entry PM 171B (Attachment D). 3. Students Who Repeat First Grade It is not necessary for a student that repeats the first grade to repeat their physical examination. A copy of the examination must be retained in the health record. 4. Students Who Repeat Kindergarten If a student is examined within six months of kindergarten entry or during the kindergarten year and has a CHDP report on file, and then repeats the kindergarten year, he/she need not repeat the health assessment. 5. Students Enrolled in Special Education Programs Many students enrolled in special education programs have extensive health records on file with the school. When there is no record of a complete health assessment within 18 months prior to first grade entry, parents/guardians should be encouraged and assisted in obtaining and submitting the report of health assessment to the school. If the parent/guardian refuses, a waiver should be obtained (Attachment D). In ungraded special education, data should be submitted on students who are age six on or before December 2 of the current school year as outlined above. 6. Schools with Ungraded Classes Students who will be age six on or before December 2 of the current year will be regarded as equivalent to students in first grade for CHDP Program purposes. Procedures for Obtaining Certification for School Entrance If the designated LAUSD school personnel are not available or the student is not financially eligible or the parent/guardian prefers their child s physical exam to be done by their provider or choose a public agency, the school/school nurse must refer Student Health and Human Services Page 3 of 13 January 22, 2013
4 the child to the appropriate public medical agency to obtain the required health screening. School personnel should never refer students to private medical agencies unless that is the student s current designated provider. If school personnel have questions regarding which public agencies to refer students, they can call either the Student Medical Services at (213) or District Nursing Services at (213) Guidelines for Blood Lead Testing In 1992, blood lead testing became a required component of the CHDP health assessment. The screening is offered to children under 72 months of age and those that are identified as high risk. The District has contracted with an outside laboratory for this testing. When the test is indicated, the CHDP School Physician or School Nurse Practitioner will complete a lab request for the family to take the child to the nearest contracted laboratory site. The Central Nursing CHDP Program will send the lead test result to the school or school clinic site to be recorded on the health record. The school nurse is responsible for notifying the parent or guardian about the blood lead results on those students with an elevated lead level of 10 ug/dl or higher. The parents must be counseled regarding possible sources of lead poisoning and nutritional guidelines to counter act elevated lead levels. The parent or guardian should be made aware that blood lead retests will be need to be repeated until there are two (2) consecutive blood lead valves under 15 mcg/dl measured 6 months apart. AUTHORITY: RELATED RESOURCES: This is a policy of California Administrative Code, Title 17, Sections 6802 et. Seq. and Health and Safety Code, Part 1, Article 3, 4, Section 320 et seq. and Child Health and Disability Prevention (CHDP) Program, California Department of Health Services, Children s Medical Services Branch, Child Health and Disability Prevention Program Los Angeles County Public Health Department, CHDP Program ASSISTANCE: For assistance or further information, please contact Student Medical Services at (213) or District Nursing Services at (213) Student Health and Human Services Page 4 of 13 January 22, 2013
5 Student Health and Human Services Page 5 of 13 January 22, 2013
6 LOS ANGELES UNIFIED SCHOOL DISTRICT Student Health and Human Services Attachment B CONSENT FOR HEALTH ASSESSMENT, ELIGIBILITY DETERMINATION AND RECEIPT/RELEASE OF MEDICAL INFORMATION FORM Child s full name Birth date School Grade Room No. Track I hereby give my consent for my child to have the physical examination, blood, urine, and Tuberculin tests and required immunizations through the school health screening program. I also authorize the receipt/release of the results of the screening to the Los Angeles Unified School District, California State Department of Health, the County of Los Angeles Department of Health Services Child Health and Disability Prevention Program and any Health Plan/providers in which my child is enrolled. Number of Persons in family Family Income Monthly PLEASE CHECK: Child is: Covered by Medi-Cal Yes Has already had school Yes No admission physical No examination? Member of Private Yes Date of last complete physical exam: Health Plan/HMO? No Name of health plan: Where was physical exam done? My child will have the Yes I wish my child to have Yes Physical exam done by No physical done at school. No a private doctor or prepaid health plan. Authorization: I consent to submission of claims to my insurance carrier(s) for fees for services provided to my child. I authorize the release of any medical information between LAUSD and my insurance carrier(s) as may be necessary to prepare a claim for services. I authorize my insurance carrier(s) to process medical claims submitted by LAUSD and to assign payment of benefits to LAUSD for these claims: Yes No X ( ) Signature of Parent or Guardian Home Phone ( ) Street Address Phone where you may be contacted during the day City Zip code Date File this form in the Health Card Student Health and Human Services Page 6 of 13 January 22, 2013
7 DISTRITO ESCOLAR UNIFICADO DE LOS ANGELES Oficina para la Salud Estudiantil y los Servicios Humanos Attachment B-1 FORMULARIO DE CONSENTIMIENTO PARA LA EVALUACIÓN DE LA SALUD, DETERMINACIÓN DE LA CLASIFICACIÓN Y RECIO O DIVULGACIÓN DEL FORMULARIO DE INFORAMACIÓN MEDICA Nombre y Apellido de niño(a) Fecha de nacimiento Escuela Grado Salón Ciclo lectivo Por la presente autorizo que mi hijo sea sometido a un examen médico, análisis de sangre, de orina y a que se le practique la prueba de la tubercolósis. También autorizo que se le den las vacunas requeridas a través del programa de evaluación inicial escolar. Además, autorizo el recibo o la divulgación de los resultados de la evaluación inicial a Distrito Escolar Unificado De Los Angeles, la Secretaría de Salud Pública del Estado de California, el Departamento de Salubridad del Condado de Los Angeles, el Programa de Salud Infantil y Prevención de Discapacidades y todo Plan de Salud al que el niño(a) pertenezca. Número de personas en la familia Ingreso familiar mensual Favor de indicar: El/la niño/a Recibe los servicios Sí Le han hecho a el/la niño/a Sí de Medi-Cal No un examen médico para el No ingreso a la escuela? Es el niño/a miembro de un Sí Fecha del último examen médico plan de salud u organización para No la administración de los servicios médicos (HMO) particular? Nombre del plan: Lugar donde se hizo el último examen médico: A mi hijo/a lo examinará un Sí Yo quiero que mi hijo/a sea Sí médico particular o un plan de No sometido a un examen médico No salud pago por anticipación. Autorización: Yo consiento a la sumisión de cobro a la compania/s de mi seguro medico por las cuotas por los servicios proveidos. Yo autorizo el compartir cualquier información medica entre mi/s seguros medico y LAUSD tan como sea necesario, para preparar el cobro por los servicios. Yo autorizo a mi seguro medico a procesar los cobros medicos sometidos por LAUSD y para asignar el beneficio de pago por estos cobros a LAUSD: Sí No X Firma del Padre/Madre o Tutor Teléfono de la casa Domicilio Teléfono donde puede ser localizado durante el día Ciudad Código Postal Fecha Student Health and Human Services Page 7 of 13 January 22, 2013
8 LOS ANGELES UNIFIED SCHOOL DISTRICT Student Health and Human Services Attachment C Use School Letterhead Date: Dear Parent/Guardian: California law requires children to have a physical examination within 18 months prior to or not later than three (3) months after entering first grade. The examination includes a health history, physical examination with vision and hearing screening, necessary immunizations, tuberculosis skin test, a test for anemia, a urine test and blood lead screening. Many physicians, group health plans and the County of Los Angeles CHDP Program offer these services. If you are covered by a private health plan you should have the examination done there. The Los Angeles Unified School District will provide this service to the families of those students who are eligible and unable to obtain this examination from their physician or clinic. Please complete the attached page to see if your family qualifies. For the exam at school, you must be present with your child. The results of the examination including any necessary referral assistance will be discussed with you. Please indicate your choice below with a check mark and return the form to the school nurse My child will have the physical examination done by a private doctor or health plan. I will provide the school with a copy of the findings. I wish to have my child examined at school and have completed the eligibility form. I do not wish my child examined for the CHDP Program and will sign the waiver form. Name of Child Room No. Sincerely, Principal Student Health and Human Services Page 8 of 13 January 22, 2013
9 DISTRITO ESCOLAR UNIFICADO DE LOS ANGELES Oficina para la Salud Estudiantil y los Servicios Humanos Attachment C-1 Fecha Estimados Padres o Tutores: La ley de California exige que los niños se hagan un examen físico dentro de los 18 meses previos a su ingreso al primer año lectivo o, a más tardar, dentro de los tres (3) meses siguientes al mismo. El examen comprende un historial de salud, examen físico con control de la visión y la audición, las inmunizaciones necesarias, una prueba de reacción a la tuberculosis, un examen para determinar si el niño pudiera tener anemia, un análisis de la orina y un control de plomo en la sangre. Muchos médicos, planes de salud y el Programa CHDP (Programa de Salud Infantil y Prevención de Discapacidades) del Condado de Los Angeles ofrecen estos servicios. Si su familia está cubierta por un plan privado de salud, debe coordinar para realizar dichos exámenes allí. El Distrito Escolar Unificado de Los Angeles les ofrecerá este servicio a las familias de aquellos estudiantes que reúnan los requisitos y cuyos médicos o clínicas no les proporcionen tales beneficios. Por favor, complete la página adjunta para determinar si su familia tiene derecho a este servicio. Para el examen en la escuela, tiene que estar presente con su hijo. Los resultados del examen, incluyendo cualquier tipo de derivación necesaria a un especialista, son temas que se tratarán directamente con usted. Por favor, indique su elección a continuación con una cruz, y entréguele el formulario a la enfermera de la escuela. 1. Mi hijo(a) se hará el examen físico a través de un doctor particular o un plan de salud privado. Le suministraré a la escuela una copia de los resultados. 2. Quisiera que mi hijo(a) fuera examinado(a) en la escuela, por lo que he completado el formulario para determinar si tenemos ese derecho. 3. No deseo que mi hijo(a) sea examinado(a) para el Programa CHDP, y firmaré el formulario de exoneración. Nombre y apellido del estudiante Salón Atentamente, Director(a) Student Health and Human Services Page 9 of 13 January 22, 2013
10 Attachment D Student Health and Human Services Page 10 of 13 January 22, 2013
11 Attachment D-1 Student Health and Human Services Page 11 of 13 January 22, 2013
12 Attachment E Student Health and Human Services Page 12 of 13 January 22, 2013
13 Attachment E-1 Student Health and Human Services Page 13 of 13 January 22, 2013
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 detalles2015 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 detalles2014 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 detallesPRINTING 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 detallesCal 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 detallesLOS 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 detallesTITLE 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 detallesOJO: 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 detalleswww.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 detallesLump 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 detallesStudent Violence, Bullying, Intimidation, Harassment
Case 4:74-cv-00090-DCB Document 1690-6 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
Más detallesTITLE 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 detallesDEPARTAMENTO 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 detallesPB #11-111-OPE. Attachment: Please use Print on M-687r Referral to Treatment Program (Rev. 11/30/11) (Rev. 11/30/11)
FAMILY INDEPENDENCE ADMINISTRATION Matthew Brune, Executive Deputy Commissioner James K. Whelan, Deputy Commissioner Policy, Procedures, and Training Stephen Fisher, Assistant Deputy Commissioner Office
Más detallesVoter 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 detallesAs 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 detallesThe 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 detallesGolden Valley High School English Language Advisory Council (ELAC) Meeting Agenda Tuesday, September 1, 2015
English Language Advisory Council (ELAC) Meeting Agenda Tuesday, September 1, 2015 1. Welcome and Introductions a. Mrs. Jennifer Ambrose: Administrator b. Mrs. Arian Wilson: ELD Coordinator, ELL & Study
Más detallesHEAD 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 detallesLOS 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 detallesAUTHORIZATION FOR USE OR DISCLOSURE OF HEALTH INFORMATION
FORM 16-1 AUTHORIZATION FOR USE OR DISCLOSURE OF HEALTH INFORMATION Completion of this document authorizes the disclosure and use of health information about you. Failure to provide all information requested
Más detallesTRENTON BOARD OF EDUCATION ''Children Come First, Los Niños son Primeros." Lucy Feria Micah Bradley-Freeman, MSN RN Interim Superintendent of School Supervisor of Nurses 609.656.4900 609.989.2682 fax lferia@trenton.k12.nj.us
Más detallesSFGH FHC Healthy Children Vaccination Program Frequently Asked Questions
SFGH FHC Healthy Children Vaccination Program Frequently Asked Questions The Family Health Center (FHC) Healthy Children Vaccination Program at SF General Hospital (SFGH) provides immunization services
Más detallesStudent 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 detallesWelcome 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 detallesPortal 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 detallesEl Abecedario Financiero
El Abecedario Financiero Unidad 4 National PASS Center 2013 Lección 5 Préstamos Vocabulario: préstamo riesgocrediticio interés obligadosolidario A lgunavezpidesdineroprestado? Dóndepuedespedirdinero prestado?
Más detallesReglamento 723-4 ESTUDIANTES 13 de junio de 2007 ESTUDIANTES. Requisitos para el examen de tuberculosis
13 de junio de 2007 Requisitos para el examen de tuberculosis Todos aquellos estudiantes de edad preescolar, escolar, o adultos, que estén intentando ingresar a las Escuelas Públicas del Condado de Prince
Más detallesI am the parent or legal guardian of.
EXHIBIT Descriptive Code: IFCB-R/E (2) FIELD TRIPS AND EXCURSIONS Date: March 9, 2006 Clarke County School District Student Travel Authorization and Teacher ation Form To SCHOOL: I am the parent or legal
Más detallesNombre de la persona completando esta forma
mbre de Paciente mbre de la persona completando esta forma Fecha Relación del paciente / / Sexo Masculino Raza Numero de Seguro Social Fecha de Nacimiento Femenino / / / / POR FAVOR LISTE TODA LA GENTE
Más detallesUNIVERSIDAD 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 detallesCPS-Parent Portal Portal Para Padres
CPS-Parent Portal Portal Para Padres Marie Sklodowska Curie Metro High School A#endance Office - Room 187 (773) 535-2150 GEAR UP - Parent Services Room 187-190 (773) 535-9833 Behind Every Successful Student
Más detallesMigrant. 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 detallesHealth Plan of Nevada, Inc.
HMO Option 1 Lifetime Maximum Benefit $1,000,000 Annual Copayment Maximum $2,000 per Member / $4,000 per Family Covered Services Physician Services - Office Visit/Consultation Hospital Services - Elective
Más detallesUNIVERSIDAD DE MONTEVIDEO
UNIVERSIDAD DE MONTEVIDEO Formulario de admisión para estudiantes internacionales Application form for International Students PHOTO Semestre 1 (marzo-julio) / Semester 1 (March-July) Año/ Year Semestre
Más detallesCreating 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 detallesRequesting Accommodations SAT and ACT. Sign and return the Parent permission form to the SSD Coordinator
Requesting Accommodations SAT and ACT SAT Sign and return the Parent permission form to the SSD Coordinator SSD Coordinator submits information online to College Board The deadline for accommodations approval
Más detallesMISSISSIPPI 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 detallesAPPLICATION 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 detallesFormulario 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 detallesRegistro 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 detallesSchool 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 detallesDaly 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 detallesAGENCY 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 detallesLOS ANGELES UNIFIED SCHOOL DISTRICT POLICY BULLETIN
TITLE NUMBER ISSUER Procedures to Permit Parents/Guardians to Ride in School Buses BUL-6398.0 Donald Wilkes, Director Transportation Services Division Enrique Boull t, Chief Operating Officer Office of
Más detallesAre you interested in helping to GOVERN the Authority, DEVELOP current and future programs, and APPROVE contracts?
Albany Housing Authority RESIDENT COMMISSIONER ELECTION Are you interested in helping to GOVERN the Authority, DEVELOP current and future programs, and APPROVE contracts? RUN FOR RESIDENT COMMISSIONER
Más detallesRhode Island Department of Health Three Capitol Hill Providence, RI 02908-5094
Rhode Island Department of Health Three Capitol Hill Providence, RI 02908-5094 www.health.ri.gov Date: December 30, 2009 To: Parents and guardians of school-aged children in Rhode Island From: Director
Más detallesFAMILY 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 detallesRENT 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 detallesThe ADE Direct Certification User Guide is a tool for authorized ADE and school district personnel to use in conjunction with the ADE Direct
The ADE Direct Certification User Guide is a tool for authorized ADE and school district personnel to use in conjunction with the ADE Direct Certification website. 1 This User Guide is a reference guide
Más detallesLOS ANGELES UNIFIED SCHOOL DISTRICT REFERENCE GUIDE
LOS ANGELES UNIFIED SCHOOL DISTRICT REFERENCE GUIDE TITLE: NUMBER: ISSUER: DATE: Complaint Response Unit /Parent Resource Network (CRU/PRN) for Parents of Students with Disabilities REF-1341.11 Jaime R.
Más detallesPROCEDIMIENTOS: 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 detallesIRS 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 detallesGuide to Health Insurance Part II: How to access your benefits and services.
Guide to Health Insurance Part II: How to access your benefits and services. 1. I applied for health insurance, now what? Medi-Cal Applicants If you applied for Medi-Cal it will take up to 45 days to find
Más detallesINFORMACIÓN 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 detallesHABERSHAM 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 detallesAssessment Required Score Met
71 RIVERSIDE UNIFIED SCHOOL DISTRICT Academic English Learners/Educational Accountability Reclassification Profile Grades K-7 STUDENT INFORMATION: Teacher: Flotron, V Name: Jayden Tran ID#: 427437 Grade:
Más detallesSpanish 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 detallesAdeudos Directos SEPA
Adeudos Directos SEPA Qué es SEPA? La Zona Única de Pagos en Euros (Single Euro Payments Area, SEPA) es un proyecto para la creación de un sistema común de medios de pago europeo. Le permitirá realizar
Más detallesINSTRUCTIONS 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 detallesFinancial Affidavit for Child Support, DC 6:5(2) Declaración Jurada de Finanzas para Manutención de Menores, DC 6:5(2).
IN THE DISTRICT CURT F CUNTY, NEBRASKA (county where Complaint filed) EN LA CRTE DE DISTRIT DEL CNDAD DE, NEBRASKA (condado donde se entabló la Demanda), ) (your full name) (su nombre completo) ) Plaintiff,/
Más detallesFor Parents and Caregivers
Who Qualifies How to Enroll WHO QUALIFIES FOR WIC: HOW TO ENROLL IN WIC: You must Bring the infant or child to the WIC office to complete initial enrollment. If the infant or child can t be there because
Más detallesEnglish Literacy Success Team, e3 Civic High October 30, 2014
English Literacy Success Team, e3 Civic High October 30, 2014 What is the English Language Success Team? The purpose of our committee is to provide an open conversation between parents, students, and teachers
Más detallesINSTRUCTIONS 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 detallesNOTICE OF FORM CHANGE NO. 06-028
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES NOTICE OF FORM CHANGE NO. 06-028 DATE 02/23/2006 TO: County Welfare Director Supply Clerk / Forms Coordinator
Más detallesNorthwestern 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 detallesRecomendación 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 detallesPeru Tourist visa Application for citizens of Costa Rica living in Ontario - Ottawa, Gatineau
Peru Tourist visa Application for citizens of Costa Rica living in Ontario - Ottawa, Gatineau Please enter your contact information Name: Email: Tel: Mobile: The latest date you need your passport returned
Más detallesNews 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 detallesVision and Hearing Program Consent for Services. I, the parent/legal guardian of, give consent Please print name of child
Vision and Hearing Program Consent for Services I, the parent/legal guardian of, give consent Please print name of child for the Cook County Department of Public Health to provide vision and/or hearing
Más detallesTEXAS DEPARTMENT OF STATE HEALTH SERVICES
TEXAS DEPARTMENT OF STATE HEALTH SERVICES DAVID L. LAKEY, M.D. COMMISSIONER P.O. Box 149347 Austin, Texas 78714-9347 1-888-963-7111 TTY: 1-800-735-2989 www.dshs.state.tx.us August 15, 2013 Dear Birthing
Más detallesPassaic County Technical Institute 45 Reinhardt Road Wayne, New Jersey 07470
Note: Instructions in Spanish immediately follow instructions in English (Instrucciones en español inmediatamente siguen las instrucciónes en Inglés) Passaic County Technical Institute 45 Reinhardt Road
Más detallesANNUAL REPORT OF GUARDIAN ON CONDITION OF WARD/INCAPACITATED PERSON INFORME ANUAL DEL TUTOR SOBRE LA CONDICIÓN DEL PUPILO/PERSONA INCAPACITADA/INHÁBIL
Nebraska State Court Form REQUIRED Formulario del Tribunal del Estado de Nebraska REQUERIDO ANNUAL REPORT OF GUARDIAN ON CONDITION OF WARD/INCAPACITATED PERSON INFORME ANUAL DEL TUTOR SOBRE LA CONDICIÓN
Más detallesBarbara Quaid. March 1, Dear Ventura County Teachers:
March 1, 2018 Dear Ventura County Teachers: The Ventura County Fair invites students to earn free carnival rides through our reading program, Read & Ride for local kindergarten through 8 th grade students.
Más detallesBeneficios de Fundar una Corporación Sin Fines de Lucro Benefits of Establishing a Non-Profit Corporation
ISSN 2152-6613 Beneficios de Fundar una Corporación Sin Fines de Lucro Benefits of Establishing a Non-Profit Corporation Evaluación Capacitación Rendimiento NPERCI Publication Series No. 2 Flordeliz Serpa,
Más detallesChild 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 detallesEncl.: Teacher/Teacher Assistant Information Request Form
To: All Parents/Legal Guardians in Title I Schools From: Charlotte-Mecklenburg Schools Title I Department Date: September 27, 2017 Subject: Right to Know Notification to Parents of Teacher and Teacher
Más detallesFORMULARIO DE AUTORIZACIÓN MIM #710-S AUTHORIZATION FORM MIM #710-S
FORMULARIO DE AUTORIZACIÓN MIM #710-S AUTHORIZATION FORM MIM #710-S 500 Eastowne Drive Chapel Hill, NC 27514 Para radiografías favor de enviar a: Radiology Films please send: ATTN: IMAGING SUPPORT (919)
Más detallesEmployee s Injury Report / Informe de lesión de empleado
Claims Administrative Services Phone: 800-765-2412 Fax: 903-509-1888 501 Shelley Drive Claims Administrative Services, Inc. Tyler, Texas 75701 Our reputation for excellence is no accident. / Nuestro prestigio
Más detallesEl 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 detallesOrden de domiciliación o mandato para adeudos directos SEPA. Esquemas Básico y B2B
Orden de domiciliación o mandato para adeudos directos SEPA. Esquemas Básico y B2B serie normas y procedimientos bancarios Nº 50 Abril 2013 INDICE I. Introducción... 1 II. Orden de domiciliación o mandato
Más detallesMY Escuelas Saludables Forma de Autorización de Padres
MY Escuelas Saludables Forma de Autorización de Padres Firmando esta forma, Yo doy consentimiento para que mi hijo tenga acceso a algún o todos los servicios disponibles de MY Escuelas Saludables, siempre
Más detallesMANUAL 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 detallesAdult 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 detallesCONSENT FOR HIV BLOOD TEST
i have been informed that a sample of my blood will be obtained and tested to determine the presence of antibodies to human immunodeficiency Virus (hiv), the virus that causes Acquired immune Deficiency
Más detallesArquidiócesis de Atlanta St. John Vianney Excursión Formulario de consentimiento de los padres/tutores y exoneración de responsabilidades
Middle School and High School Retreat March 15-17 Cost $60.00 Per Student 90.00 If you have 2 students attending These retreats are 2 separate retreats held at the same camp. The students preparing for
Más detallesDown Payment Assistance Application Packet
Down Payment Assistance Application Packet Please assure that all needed items are attached and complete. Please note that your application will not be considered until all documents are received. 1. Down
Más detallesALERT. Customers inquiring about the letter must be asked if he/she has filed 2014 tax return and:
ALERT Customers who received a premium tax credit in 2014 and are preparing to renew his/her health coverage for 2016 are required to have filed his/her 2014 taxes in order to continue receiving his/her
Más detallesLa Compensación por Desempleo Instrucciones para Solicitar los Documentos de la Proposición de Pruebas
La Compensación por Desempleo Instrucciones para Solicitar los Documentos de la Proposición de Pruebas Si tiene un caso pendiente ante la Oficina de Apelaciones de casos de Compensación por Desempleo,
Más detallesHOMEWORK 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 detalles2770 South Taylor Street Arlington, Virginia Phone: (703) STUDENT ATHLETE ACCIDENT INSURANCE COVERAGE
Arlington Public Schools FACILITIES AND OPERATIONS September 5, 2017 2770 South Taylor Street Arlington, Virginia 22206 Phone: (703) 228-7740 STUDENT ATHLETE ACCIDENT INSURANCE COVERAGE Dear Parent/Guardian,
Más detallesEncl.: Teacher/Teacher Assistant Information Request Form
To: All Parents/Legal Guardians in Title I Schools From: Charlotte-Mecklenburg Schools Title I Department Date: Subject: Right to Know Notification to Parents of Teacher and Teacher Assistant Qualifications
Más detallesDEPARTMENT OF PUBLIC HEALTH
DEPARTMENT OF PUBLIC HEALTH COUNTY OF SAN BERNARDINO OFFICE OF PUBLIC HEALTH ADMINISTRATION 351 North Mountain View Avenue, Third Floor -0010 (909) 387-9146 Fax (909) 387-6228 TRUDY RAYMUNDO Assistant
Más detallesODJFS Bureau of Civil Rights. ODJFS Bureau of Civil Rights. ODJFS Bureau of Civil Rights. ODJFS Bureau of Civil Rights
ODJFS Bureau of Civil Rights I NEED AN INTERPRETER, PLEASE. Title VI of the Civil Rights Act of 1964 prohibits discrimination on the basis of national origin. If you do not speak English well, social services,
Más detallesCivil Rights Complaint Form
Civil Rights Complaint Form Title VI of the 1964 Civil Rights Act and related non-discrimination statutes and regulations require that no person in the United States shall, on the ground of race, color,
Más detallesFAMILY 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 detallesIMPORTANT 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 detallesSi 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 detallesAffordable Care Act Informative Sessions and Open Enrollment Event
2600 Cedar Ave., P.O. Box 2337, Laredo, TX 78044 Hector F. Gonzalez, M.D., M.P.H Tel. (956) 795-4901 Fax. (956) 726-2632 Director of Health News Release. Date: February 9, 2015 FOR IMMEDIATE RELEASE To:
Más detalles