SYNERGY REGISTRATION

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

Download "SYNERGY REGISTRATION"

Transcripción

1 SYNERGY REGISTRATION Office for Youth Ministry Dear Parish Leader, First of all, we appreciate you joining us for SYNERGY The theme for this year is VICTORIOUS! We pray this event will bring you and your group closer to Christ. Enclosed you will find: Registration Instructions Synergy Code of Behavior Synergy Chaperone Responsibilities (due back to our office) Registration Form (due back to our office) Description of Workshop Presenters Parental Consent Form and Liability Waiver (to be kept with you) (Available in English and Spanish) Instructions: Please include all youth and chaperones in the Registration Form. Parental Consent Forms must be filled out for every minor attending and should be kept in your possession. We need every chaperone to read and sign the responsibilities form (turn into OYM office). This year we will be offering 5 workshops during 2 separate time slots, please select the top 3 presenters for your group. Your group will be assigned to attend one workshop for one of the time slots and will get to spend time in our outdoor thematic park during the other time slot. The cost for the event is $30.00 per person. All registration forms are due back in our office by no later than March 11 th ( for the early rate to apply). After March 11 th forms will be accepted at $35.00 per person. No registrations will be accepted after March 25 th. No refunds will be given after March 25 th. Food is not included in the price. You have the option of purchasing dinner combos ahead of time (in your registration). Combo #1 ($4) will include 1 hotdog, chips, cookie and a bottle of water. Combo #2 ($5) will include 2 hotdogs, chips, cookie and a bottle of water; if your group would prefer to have something different for dinner please make the appropriate arrangements. There are many restaurants nearby that can deliver food. Be aware that youth are not allowed to leave Mater Dei Catholic High School during Synergy. Food will also be available for purchase onsite but only during lunch time. Once the registration forms have been received, we will have an additional packet for you with wristbands and additional details for Synergy. We look forward to a successful and spirit filled day! Thank you, The Youth Office

2 Synergy Code of Behavior We are happy and excited that you are joining us as part of Synergy The Code of Behavior has been developed as a way of helping participants understand what is expected of them. The following rules of conduct will help our event go smoothly and ensure the safety of all participants. Please read and sign the form with your parents and return it to your Youth Minister. 1. As necessary as rules are to maintain order, they can't and won't guarantee a successful Synergy experience. Success depends on people's willingness to work together for the common good. 2. Participants take part in Synergy as part of a parish or school team. The adult leader of each team maintains primary responsibility for the actions of his or her team members. The sponsoring parish and the families of team members assume responsibility for any damage done to the facilities. 3. Participants are expected to attend all sessions unless explicitly excused by the Program Director. 4. Wristbands should be worn during all program activities. 5. Dress for Synergy is casual; however shirts and shoes must be worn at all times. No short shorts, halter tops, tube tops, or sagging pants, modesty is important. Please keep undergarments under your garments. 6. Socializing should take place only when permitted. 7. Be respectful of your surroundings. Surroundings include people, property, motor vehicles, etc. 8. No fighting, weapons, fireworks, lighters, or explosives are permitted. 9. The purchase, possession or consumption of alcohol or drugs by participants will result in immediate dismissal from the program. Major infractions of the Code of Behavior will meet with the same consequences. I have read and understood this code of behavior and I agree to abide by the rules above. I understand that failure to comply with the code may result in my dismissal from the event. (Teen Participant) Date (Parent/Legal Guardian) Date

3 CHAPERONE RESPONSIBILITIES SYNERGY YOUTH RALLY Group Leaders and Chaperones must read, understand, agree, sign and return this form with their liability forms. Please be sure that the Group Leader, the adult chaperones and your youth understand and abide by these policies. Basic Role of Chaperones: Chaperones must be 21 years of age or older, of good moral character and judgment. Chaperones must meet the requirements of their local diocese for working with youth, and by signing this form agree to comply with their local Diocesan Child Protection/Safe Environment Policies. For the safety and well-being of all conference participants and volunteers, the Diocese of San Diego-Office for Youth Ministry, depends on the adult example of obedience and cooperation with the policies and procedures as well as with our staff and volunteers on site. Chaperones should feel comfortable directing, sharing, and praying with their youth. Youths must be accompanied by a chaperone at all times. In case of an emergency contact your parish youth minister. Detailed Chaperone Responsibilities: Including, but not limited to the following: Appropriate Dress All participants are expected to dress in a fashion that represents modesty and good taste, respecting other participants and our Lord. Clothing must cover all undergarments and midriffs. Conduct It is expected that youth and adults will follow the directions of ALL Synergy Staff, Security, and Volunteers. Any instances of lack of cooperation or insubordination will not be tolerated and will be subject to appropriate discipline. All discipline problems regarding teenage participants will be brought to the attention of their Group Leader. Drugs, Alcohol and Weapons All alcohol, drugs and weapons are prohibited from Synergy. All state and local laws concerning alcohol, drugs and weapons will be strictly enforced. Violators will be subject to appropriate discipline and legal procedures. Guests Only registered participants are allowed to participate in Synergy. No guests are allowed. Health Issues In the event of a medical emergency, contact your parish youth minister for immediate assistance. For nonemergency medical needs, all participants will be directed to Synergy s First Aid Center. This center is available during Synergy s event hours. Any special needs should be reported on the participants waivers and again prior to check in to any diocesan staff. Ministry The primary role of the chaperone is to minister to the teens. This cannot happen if you are not with them. As a chaperone you must accompany your teens at all times. Adults should not take youth off site, except in the case of emergency. I, (Chaperone), have read, understand, and agree to the above policies. I will support the regulations and policies stipulated for Synergy. I certify that I meet the standards and requirements of my diocese for working with minor age youth. Adult Chaperone Signature Date

4 Synergy Registration Form Saturday April 11 th, 2015 Mater Dei Catholic High School Diocese of San Diego - Office for Youth Ministry THERE IS NO REGISTRATION THE DAY OF SYNERGY 1. A maximum of 10 youths can be registered per 1 paid adult chaperone. 2. Registration fee is $30 per person until March 11 th. $35 thru March 25 th - Food not included 3. No registrations will be accepted after March 25 th. 4. Full Payment is due April 25 th. Mail all Checks payable to: Office for Youth Ministry, P.O. Box 85728, San Diego CA No refunds will be available after March 25 th 6. Optional Dinner Coupons can be purchased - $4 or $5 combo 7. Questions call , fax , or Please Print Clearly Diocese Parish School/ Org. City State Contact Person: (if attending please include yourself below where applicable) Name Day Phone ( ) Address Eve. Phone ( ) City State Zip Adult Chaperone: $30 $35 First Name Last Name Thru Mar. 11- Mar. 11 March 25 Registrants (print clearly: check if Adult) Adult Youth First Name Last Name $60 $70 $90 $105 $120 $140 $150 $175 $180 $210 $210 $245 $240 $280 $270 $315 $300 $350 $330 $385 Workshop Choice for Group: 1 st 2 nd 3 rd Waiver Certification: I hereby certify that all youth participants have submitted the required waivers, # of Dinner Combos $4 Combo: $5Combo: Signature of Parish Representative Printed Name of Parish Representative Total Cost:

5 SYNERGY PRESENTER LIST 2015 (A) PRESENTER: Jamie Cleaton Jamie Cleaton is a local San Diegan who has been led on numerous adventures spanning the globe and now uses those experiences and his passionate speaking to invite young people into the greatest adventure, that of following Christ into fullness of life. Jamie has been active in youth ministry for 10 years and has been speaking professionally since He has been blessed to speak to thousands of high schoolers and young adults all across the United States (B) PRESENTERS: Jeremy and Ryan Jeremy and Ryan have been recognized as one of the best up and coming Catholic Rock artists today. They are very humbled by the gifts and opportunities that God has given them, and they are excited about what the future holds. (C) PRESENTER: Briana Robell Ralph Waldo Emerson said, To be yourself in a world that is constantly trying to make you something else is the greatest accomplishment. In life, we have two worlds to figure out: the Work World and the Social World. In the Work World it s all about grades, classes, and career. In the Social World it s all about friends, family, love interests, parties, and sex. As a singer and pianist, Bri opens with secular music and reveals a method that will help you discover your uniqueness in a world that s constantly trying to make you something else. Bri creates a down-to-earth, judgment-free zone that gives clarity when it comes to choosing what s most beneficial in the Social World. To hear and read more check out Bri s website at (D) PRESENTERS: Love Resonate Love Resonate is dedicated to making the love of Christ resonate within the hearts of people across the earth. Devoted to worship and ministry; Love, Resonate is comprised of musicians, ministers, and worship leaders. Based in Southern California, they are blessed to share the love of Christ manifested in art, music, and ministry. (E) PRESENTER: Nina Baumgardner Jesus is risen Got joy? Do you know what joy even is? Come hear about what joy is, where you can find it, and why your life needs it. Nina is the Coordinator of Youth Ministry at St. Therese of Carmel in our very own Diocese of San Diego!

6 PARENTAL/GUARDIAN CONSENT FORM AND LIABILITY WAIVER PARTICIPANT S NAME: BIRTH DATE: SEX: PARENT/GUARDIAN S NAME: HOME ADDRESS: HOME PHONE: ( ) MOBILE PHONE: ( ) I,, (parent/guardian) grant permission to, (name of youth) to participate in this parish youth ministry event that requires transportation to a location away from the parish site. This activity will take place under the guidance and direction of parish employees from (name of parish). A brief description of the activity follows: Name of event or activity: Destination of event or activity: Name of individual in charge: Estimated time of departure and return: Mode of transportation to and from event: As parent and/or legal guardian, I remain legally responsible for any personal actions taken by (name of youth). I, (parent/guardian) agree on behalf of myself, my child s other parent if known or living, or our heirs, successors, and assignees, to hold harmless and defend (name of parish), the Diocese of San Diego; its officers, directors, agents, volunteers, chaperones, and representatives associated with the event with respect to any and all actions, claims or demands that may be made or brought against the parish, the Diocese of San Diego; its officers, directors, agents, volunteers, chaperones, and representatives associated with the event, arising from or in connection with my child attending this event or in connection with any illness, injury or cost of medical treatment in connection therewith. I agree to compensate the parish, the Diocese of San Diego; its officers, directors, agents, volunteers, chaperones, and representatives associated with this event for reasonable attorney s fees and expenses arising in connection therewith. Signature Date MEDICAL MATTERS: I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for his/her health. *Of the following statements pertaining to medical matters, sign only those in accordance with your wishes* EMERGENCY MEDICAL TREATMENT: In the event of an emergency, I hereby grant permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment administered by the hospital or doctor. In the event of an emergency, if you are unable to reach me at the above numbers, please contact: NAME & RELATIONSHIP: PHONE: ( ) (HOME/MOBILE) FAMILY DOCTOR: PHONE: ( ) FAMILY HEALTH PLAN CARRIER: POLICY NUMBER: Signature Date

7 OTHER MEDICAL TREATMENT: In the event it comes to the attention of the parish, the Diocese of San Diego; its officers, directors, agents, volunteers, chaperones, and representatives associated with the activity that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever or diarrhea, I want to be contacted. Signature Date MEDICATIONS: My child is taking medication at present. My child will bring all medications necessary, and such medications will be well labeled. Names of medications and concise instructions for seeing that the child takes such medications, including dosage and frequency of dosage is as follows: Signature Date MEDICATIONS: CHOOSE ONE OF THE BELOW LISTINGS: (A OR B) A) No medication of any type whether prescription or non-prescription may be administered to my child unless the situation is lifethreatening and emergency treatment is required. A) Signature Date B) I hereby grant permission for nonprescription medication (such as aspirin, throat lozenges, cough syrup) to be given to my child, if deemed advisable. B) Signature Date SPECIFIC MEDICAL INFORMATION The parish will take reasonable care to see that the following information will be held in confidence. Allergic reactions (medications, foods, plants, insects, etc.) Immunizations: Date of last tetanus/diphtheria immunization: Does child have a medically prescribed diet? Any physical limitations? Is child subject to chronic homesickness, emotional reactions to new situations, sleepwalking, bedwetting, fainting? Has child recently been exposed to contagious disease or conditions, such as mumps, measles, chickenpox, H1N1, etc.? If so, date and disease or condition: You should be aware of these special medical conditions of my child: PHOTO/VIDEO RELEASE I, (parent/guardian) authorize the Office for Youth Ministry (OYM) of the Catholic Diocese of San Diego, its representatives, or volunteers, to photograph or record on audio or video (tape or digital) (name of youth) for purposes of furthering the mission of the OYM, in this specific case, the creation of publication materials for adults who participate in (event & date). Photos, audio, or video may be used in printed materials and any other visual display or media. I understand that such photos and/or video recordings will be used for OYM related purposes and will not be used for any commercial purpose whatsoever. I therefore hereby waive any kind and all rights I may have for remuneration of any kind that could otherwise accrue for the uses of such photos and/or audio or video recordings. Signature Date

8 CONSENTIMIENTO DEL PADRE/TUTOR EXENCIÓN DE RESPONSABILIDAD E INFORMACION MÉDICA NOMBRE DEL PARTICIPANTE: FECHA DE NACIMIENTO: SEXO: NOMBRE DEL PADRE(S) O TUTOR: DOMICILIO: TELEFONO (CASA): ( ) TELEFONO (MOBIL): ( ) Yo,, (padre/tutor) otorgo permiso a, (nombre del participante) a que forme parte de este evento parroquial/diocesano del ministerio juvenil. Entiendo que se requiere el transporte a un lugar fuera del sitio parroquial. Este evento se llevara acabo bajo la orientación y dirección de los empleados de la parroquia de (nombre de la parroquia). Una breve descripción de el evento sigue: Nombre del Evento: Lugar del Evento: Nombre del individuo a cargo: Tiempo de partida y retorno: Medio de Transporte: Como padre y/o tutor legal, permanezco legalmente responsable por cualquier acción personal tomada por (nombre del participante). Yo,, (padre/tutor) estoy de acuerdo en nombre de mi hijo(a), esposo(a), sucesores, herederos, y cesionarios de mantener indemne de toda responsabilidad y defender a (nombre de la parroquia), la Diócesis de San Diego; sus funcionarios, directores, agentes, voluntarios, acompañantes, y representantes asociados con el evento; con respecto a cualquier y todas las acciones, reclamaciones o demandas que puedan introducirse, o ya en contra de la parroquia, la Diócesis de San Diego, sus oficiales, directores, agentes, voluntarios, acompañantes y representantes asociados con el evento, que surja de o en conexión con mi niño que asiste a este evento o en conexión con cualquier enfermedad, lesión o costo del tratamiento médico al respecto. Estoy de acuerdo en compensar a la parroquia, la Diócesis de San Diego, sus oficiales, directores, agentes, voluntarios, acompañantes y representantes asociados a este evento, los honorarios razonables de abogados y gastos generados en relación con la misma. Firma Fecha ASUNTOS MEDICOS: Afirmo que mi hijo(a) está en buena salud, y asumo toda responsabilidad sobre la misma. * Favor de contestar el siguiente cuestionario medico, solo firme aquello que este de acuerdo a sus deseos * TRATAMIENTO MEDICO DE EMERGENCIA: En el caso de una emergencia, yo doy permiso para transportar a mi hijo(a) a un hospital para tratamiento de emergencia médica o quirúrgica. Deseo ser informado antes de cualquier tratamiento adicional administrado por el hospital o el médico. En el caso de una emergencia, si no pueden comunicarse conmigo, favor de llamar: NOMBRE & RELACION: TELEFONO: ( ) (CASA/MOBIL) MÉDICO FAMILIAR: PHONE: ( ) NOMBRE DE ASEGURANZA/PLAN DE SALUD: NUMERO DE POLIZA: Firma Fecha

9 OTRO TRATAMIENTO MEDICO: En el caso que algún empleado parroquial, la Diócesis de San Diego, sus oficiales, directores, agentes, voluntarios, acompañantes y representantes asociados con el evento, vea necesaria la administración de medicamento a mi hijo(a) por presentar síntomas tales como dolor de cabeza, vómitos, dolor de garganta, fiebre o diarrea, deseo que me notifiquen inmediatamente antes de administrar cualquier medicamento. Firma Fecha MEDICAMENTOS: Mi hijo (a) actualmente esta bajo el siguiente tratamiento. Mi hijo (a) se hará cargo de llevar todos sus medicamentos y de tenerlos bien etiquetados. Los nombres de los medicamentos e instrucciones concisas para la administración, dosis y frecuencia es la siguiente: Firma Fecha MEDICAMENTOS: FAVOR DE ESCOJER UNA DE LAS OPCIONES: (A O B) A) Ningún tipo de medicamento deberá ser administrado al menos que se encuentre la vida de mi hijo (a) en peligro de muerte y sea necesaria atención medica. A) Firma Fecha B) Yo otorgo permiso para que se le administre medicamento sin receta a mi hijo (a) como (aspirinas, pastillas para la garganta, jarabe para la tos) si la situación lo amerita. B) Firma Fecha DATOS IMPORTANTES MEDICOS La parroquia se tomara el cuidado especial de ver que la siguiente información se mantenga confidencial. Reacciones Alérgicas (medicamentos, comidas, plantas, insectos,etc. ) Vacunas: Fecha de la vacuna ante el tétano/difteria: Lleva su hijo (a) una dieta especial? Alguna limitación física? Su hijo (a) padece de nostalgia crónica, reacciones emocionales a las nuevas situaciones, el sonambulismo, orinarse en la cama o desmayos? Su hijo (a) ha estado expuesto a alguna enfermedad contagiosa o condiciones, como las paperas, el sarampión, la varicela, el H1N1, etc? En caso afirmativo, anote la fecha y la condición o enfermedad: También deben de estar conscientes de las siguientes condiciones médicas especiales de mi hijo (a): FOTO/VIDEO PRENSA Yo, (padre /tutor) autorizo a la Oficina de Jóvenes de la Diócesis Católica de San Diego, sus representantes, o voluntarios, para fotografiar o grabar en cinta de audio o vídeo (digital) a (nombre del participante) con fines de promover la misión del Ministerio de Jóvenes, en este caso específico, la creación de materiales de publicación para los que participan en ( evento y fecha). Fotos, audio o video puede ser utilizados en materiales impresos y pantallas de visualización o de otros medios de comunicación. Entiendo que este tipo de fotos y / o grabaciones de vídeo se utilizará para fines relacionados con el Ministerio de Jóvenes y no serán utilizados con fines comerciales de ningún tipo. Por lo tanto, la presente renuncio a cualquier tipo y todos los derechos que pueda tener una remuneración de cualquier clase que de otro modo se podrían derivar para los usos de estos tipos de fotos y/o grabaciones de audio o video. Firma Fecha

Arquidiócesis de Atlanta St. John Vianney Excursión Formulario de consentimiento de los padres/tutores y exoneración de responsabilidades

Arquidiócesis 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 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

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

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

I am the parent or legal guardian of.

I 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 detalles

DIOCESE OF CORPUS CHRISTI RETIRO DE CONFIRMACIÓN DIOCESANO

DIOCESE OF CORPUS CHRISTI RETIRO DE CONFIRMACIÓN DIOCESANO DIOCESE OF CORPUS CHRISTI 620 Lipan St. Corpus Christi, Texas 78401 Pastoral Parish Services Office of Youth Ministry (361) 882-6191 Fax (361) 693-6737 www.diocesecc.org/youth YouthOffice@diocesecc.org

Más detalles

Canutillo Middle School 7311 Bosque, P.O. Box 100 Canutillo, Texas 79835 (915) 877-7900 Fax (915) 877-7919

Canutillo Middle School 7311 Bosque, P.O. Box 100 Canutillo, Texas 79835 (915) 877-7900 Fax (915) 877-7919 Mark Paz August 24, 2015 Dear Parents/Legal Guardian, I would like to start by thanking each and every single one of you for the tremendous help and support we have been receiving. Thank You! Next school

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

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

Harmony Science Academy Houston High 9431 W. Sam Houston Pkwy S Houston, TX, 77099

Harmony Science Academy Houston High 9431 W. Sam Houston Pkwy S Houston, TX, 77099 Dear HSA-Houston High Parents/Guardians, We hope that everyone is having a wonderful summer. Student orientation is drawing near and to make the process run smoother, we are asking that you please complete

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

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

MajestaCare Healthy Baby Program

MajestaCare Healthy Baby Program MajestaCare Healthy Baby Program Helping you have a healthy baby Para que tenga un bebé saludable Your baby s provider After your baby becomes a member of MajestaCare health plan, you will get a letter

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

\RESOURCE\ELECTION.S\PROXY.CSP

\RESOURCE\ELECTION.S\PROXY.CSP The following is an explanation of the procedures for calling a special meeting of the shareholders. Enclosed are copies of documents, which you can use for your meeting. If you have any questions about

Más detalles

SFGH FHC Healthy Children Vaccination Program Frequently Asked Questions

SFGH 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 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

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

Learning Compact. Schools would agree to provide children every opportunity to learn in a supportive, drug- and violence-free environment.

Learning Compact. Schools would agree to provide children every opportunity to learn in a supportive, drug- and violence-free environment. Learning Compact What is a learning compact? A learning compact is a voluntary agreement between the home and school. The agreement would define goals, expectations and shared responsibilities of schools

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

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

ANNUAL REPORT OF GUARDIAN ON CONDITION OF WARD/INCAPACITATED PERSON INFORME ANUAL DEL TUTOR SOBRE LA CONDICIÓN DEL PUPILO/PERSONA INCAPACITADA/INHÁBIL

ANNUAL 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 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

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

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

Guide 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. 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 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

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

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

School Compact Flat Rock Middle School School Year 2015-2016

School Compact Flat Rock Middle School School Year 2015-2016 School Compact School Year 2015-2016 Dear Parent/Guardian, Flat Rock Middle, students participating in the Title I, Part A program, and their families, agree that this compact outlines how the parents,

Más detalles

The 10 Building Blocks of Primary Care

The 10 Building Blocks of Primary Care The 10 Building Blocks of Primary Care My Action Plan Background and Description The Action Plan is a tool used to engage patients in behavior-change discussion with a clinician or health coach. Using

Más detalles

Improving Rates of Colorectal Cancer Screening Among Never Screened Individuals

Improving Rates of Colorectal Cancer Screening Among Never Screened Individuals Improving Rates of Colorectal Cancer Screening Among Never Screened Individuals Northwestern University, Feinberg School of Medicine Contents Patient Letter Included with Mailed FIT... 3 Automated Phone

Más detalles

Passaic County Technical Institute 45 Reinhardt Road Wayne, New Jersey 07470

Passaic 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 detalles

GUIDE FOR PARENT TEACHER CONFERENCES

GUIDE FOR PARENT TEACHER CONFERENCES GUIDE FOR PARENT TEACHER CONFERENCES A parent-teacher conference is a chance for you and your child s teacher to talk. You can talk about how your child is learning at home and at school. This list will

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

Frontier Schools 2013 Summer Camp at Science City

Frontier Schools 2013 Summer Camp at Science City Frontier Schools 2013 Summer Camp at Science City Weekly Camps for Ages 6 12 July 8 August 9 (no session July 1 5) Monday Friday 9 a.m 4 p.m. Ignite your child s natural curiosity! Activities include exploration

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

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

Bienvenidos a Primer Grado Welcome to first grade

Bienvenidos a Primer Grado Welcome to first grade Bienvenidos a Primer Grado Welcome to first grade Mrs. Pulido Mrs. Howard Mrs. Escamilla Maestras del programa doble sendero Dual Language Teachers En la mañana Morning Procedures El desayuno se sirve

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

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

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

Screener for Peer Supporters

Screener for Peer Supporters Screener for Peer Supporters Primary Recruiter: Secondary Recruiter: Potential Peer Supporter Name: Phone #1: Home/Cell Phone #2: Home/Cell Address: City: Zip: Contact 1: Date: / / Contact 2: Date: / /

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

Dolores de cabeza Trabaje con su doctor para evitar las visitas a la Sala de Emergencia

Dolores de cabeza Trabaje con su doctor para evitar las visitas a la Sala de Emergencia Headaches, Working with your Doctor to Avoid the Emergency Room Dolores de cabeza Trabaje con su doctor para evitar las visitas a la Sala de Emergencia Conozca a su equipo de cuidados para los dolores

Más detalles

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

Cómo comprar en la tienda en línea de UDP y cómo inscribirse a los módulos UDP

Cómo comprar en la tienda en línea de UDP y cómo inscribirse a los módulos UDP Cómo comprar en la tienda en línea de UDP y cómo inscribirse a los módulos UDP Sistema de registro y pago Este sistema está dividido en dos etapas diferentes*. Por favor, haga clic en la liga de la etapa

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

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

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

AUTHORIZATION FOR USE OR DISCLOSURE OF HEALTH INFORMATION

AUTHORIZATION 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 detalles

Citizenship. Citizenship means obeying the rules and working to make your community a better place.

Citizenship. Citizenship means obeying the rules and working to make your community a better place. Citizenship Citizenship means obeying the rules and working to make your community a better place. I show good citizenship when I help keep my school and community clean. I am a good citizen when I follow

Más detalles

Tres componentes importantes del programa Título I El propósito del Título I es de asegurar que todos los estudiantes tengan la oportunidad de

Tres componentes importantes del programa Título I El propósito del Título I es de asegurar que todos los estudiantes tengan la oportunidad de Qué es Titulo I? El programa Título I para la Educación Primaria y Secundaria es el programa educacional más grande que recibe fondos federales El gobierno federal proporciona asistencia financiera a las

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

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

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

PB #11-111-OPE. Attachment: Please use Print on M-687r Referral to Treatment Program (Rev. 11/30/11) (Rev. 11/30/11)

PB #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 detalles

Rhode Island Department of Health Three Capitol Hill Providence, RI 02908-5094

Rhode 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 detalles

SIGUIENDO LOS REQUISITOS ESTABLECIDOS EN LA NORMA ISO 14001 Y CONOCIENDO LAS CARACTERISTICAS DE LA EMPRESA CARTONAJES MIGUEL Y MATEO EL ALUMNO DEBERA

SIGUIENDO LOS REQUISITOS ESTABLECIDOS EN LA NORMA ISO 14001 Y CONOCIENDO LAS CARACTERISTICAS DE LA EMPRESA CARTONAJES MIGUEL Y MATEO EL ALUMNO DEBERA SIGUIENDO LOS REQUISITOS ESTABLECIDOS EN LA NORMA ISO 14001 Y CONOCIENDO LAS CARACTERISTICAS DE LA EMPRESA CARTONAJES MIGUEL Y MATEO EL ALUMNO DEBERA ELABORAR LA POLITICA AMBIENTAL PDF File: Siguiendo

Más detalles

INFORMACION BASICA DEL PACIENTE

INFORMACION BASICA DEL PACIENTE INFORMACION BASICA DEL PACIENTE Apellido del paciente Primer nombre Segundo nombre Dirección Número de apartamento Ciudad Estado Código Postal Teléfono primario ( ) Secundario ( ) Trabajo ( ) Fecha de

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

DIOCESE OF YAKIMA - CATHOLIC MUTUAL GROUP

DIOCESE OF YAKIMA - CATHOLIC MUTUAL GROUP DIOCESE OF YAKIMA - CATHOLIC MUTUAL GROUP FIELD TRIP YOUTH PROGRAMS RISK MANAGEMENT INFORMATION February 2012 OVERVIEW The purpose of the enclosed information is to provide sample forms and procedures

Más detalles

Learning Masters. Fluent: Wind, Water, and Sunlight

Learning Masters. Fluent: Wind, Water, and Sunlight Learning Masters Fluent: Wind, Water, and Sunlight What I Learned List the three most important things you learned in this theme. Tell why you listed each one. 1. 2. 3. 22 Wind, Water, and Sunlight Learning

Más detalles

Roseland Charter School Roseland University Prep and Roseland Accelerated Middle School

Roseland Charter School Roseland University Prep and Roseland Accelerated Middle School Roseland Charter School Roseland University Prep and Roseland Accelerated Middle School In order to participate in athletics your student must: Have and maintain at least a 2.0 GPA ( C average). Have the

Más detalles

Summer Reading Program. June 1st - August 10th, 2015

Summer Reading Program. June 1st - August 10th, 2015 June 1st - August 10th, 2015 Dear Educator, Attached you will find three flyer templates. You can use any of these templates to share your Group Number (GN) with your group participants. 1. 2. 3. The first

Más detalles

Ausentismo (Truancy - Why it's important to go to school)

Ausentismo (Truancy - Why it's important to go to school) Ausentismo (Truancy - Why it's important to go to school) By Jesus Villasenor-Ochoa Reproduced with permission of the University of MN 2003 BRYCS is a project of the United States Conference of Catholic

Más detalles

Administración de ingresos. Voluntaria

Administración de ingresos. Voluntaria Administración de ingresos Voluntaria Qué es Administración de ingresos (Income Management)? La Administración de ingresos (Income Management) es una manera de ayudarle a administrar su dinero a fin de

Más detalles

A Member of My Community

A Member of My Community Connection from School to Home Kindergarten Social Studies Unit 1 A Member of My Community Here is an easy activity to help your child learn about what it means to be a member of a community. Here is what

Más detalles

Affordable Care Act Informative Sessions and Open Enrollment Event

Affordable 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

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

Speak Up! In Spanish. Young s Language Consulting. Young's Language Consulting. Lesson 1 Meeting and Greeting People.

Speak Up! In Spanish. Young s Language Consulting. Young's Language Consulting. Lesson 1 Meeting and Greeting People. Buenos días Good morning Buenos días Good afternoon Buenas tardes Good evening Buenas tardes Good night Buenas noches Sir Señor Ma am/mrs. Señora Miss Señorita Buenas tardes Culture Note: When greeting

Más detalles

Sistema Escolar de la Ciudad de Calhoun KEEP Programa de Estudiantes/Manual para Padres

Sistema Escolar de la Ciudad de Calhoun KEEP Programa de Estudiantes/Manual para Padres Sistema Escolar de la Ciudad de Calhoun KEEP Programa de Estudiantes/Manual para Padres Este manual describe las políticas de los empleados y los procedimientos seguidos por el Sistema Escolar de la Ciudad

Más detalles

FINANCIAL MANAGEMENT SERVICES RISK MANAGEMENT. Procedures for Filing Your Claim

FINANCIAL MANAGEMENT SERVICES RISK MANAGEMENT. Procedures for Filing Your Claim FINANCIAL MANAGEMENT SERVICES RISK MANAGEMENT Procedures for Filing Your Claim Notice: Prerequisite to Lawsuit for Damages Charter XXVII, Section 25, Charter of the City of Fort Worth States in part,.

Más detalles

Connection from School to Home Science Grade 5 Unit 1 Living Systems

Connection from School to Home Science Grade 5 Unit 1 Living Systems Connection from School to Home Science Grade 5 Unit 1 Living Systems Here is an activity to help your child understand human body systems. Here is what you do: 1. Look at the pictures of the systems that

Más detalles

AFFIDAVIT PARA VIAJE EDUCATIVO PANAMA Release for Educational Trip PANAMA. Yo (Nosotros), y seguro I (We) and,

AFFIDAVIT PARA VIAJE EDUCATIVO PANAMA Release for Educational Trip PANAMA. Yo (Nosotros), y seguro I (We) and, AFFIDAVIT PARA VIAJE EDUCATIVO PANAMA Release for Educational Trip PANAMA Yo (Nosotros), y seguro I (We) and, social número 000-000-, y 000-00- mayor (es) de edad, y vecino (s) social security number 000-000-,

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

CO148SPA.1206 PAGE 1 OF 3

CO148SPA.1206 PAGE 1 OF 3 Assurance of Support Algunos inmigrantes necesitan obtener una Assurance of Support (AoS) (Garantía de mantenimiento) antes de que se les pueda conceder su visado para vivir en Australia. El Department

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

WELCOME to the CESDP Back to School Family and Youth/Student Leadership Institute!

WELCOME to the CESDP Back to School Family and Youth/Student Leadership Institute! WELCOME to the CESDP Back to School Family and Youth/Student Leadership Institute! We are so glad that you are joining us this year and hope that you enjoy your stay. We have included the institute schedule,

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

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

Otros datos pertinentes:

Otros datos pertinentes: REGISTRO DE CUIDADO DE NIÑOS EN EL HOGAR CHILD CARE HOME REGISTER FECHA DE COMIENZO DE CUIDADO DEL NIÑO FECHA DE TERMINACIÓN DE CUIDADO DEL NIÑO NOMBRE DEL NIÑO APELLIDO PRIMER NOMBRE SEGUNDO NOMBRE USADO

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

Aula Inglés SOLICITUD FAMILIA para AU PAIRS - FAMILY APPLICATION for AU PAIRS DETALLES DE CONTACTO -CONTACT DETAILS Nombre /Full Name Dirección/Address FOTO/PHOTO Provincia / Region Ciudad - City: País/Country

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

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

Back to S chool. Information Sheets (K-6) Ashley Sanderson Flying High in First Grade

Back to S chool. Information Sheets (K-6) Ashley Sanderson Flying High in First Grade Back to S chool Information Sheets (K-6) Ashley Sanderson Flying High in First Grade Welcome Pre-K Parents Please help me get to know your child by filling out the following form! Thank you! Child s name:

Más detalles

Get an early start. Read this first. Use these Back-to-School flyers to reach parents early in the school year.

Get an early start. Read this first. Use these Back-to-School flyers to reach parents early in the school year. Get an early start. Read this first. Use these Back-to-School flyers to reach parents early in the school year. Choose your favorite style, complete the form, then make enough copies to distribute them

Más detalles

CPS-Parent Portal Portal Para Padres

CPS-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 detalles

Puede pagar facturas y gastos periódicos como el alquiler, el gas, la electricidad, el agua y el teléfono y también otros gastos del hogar.

Puede pagar facturas y gastos periódicos como el alquiler, el gas, la electricidad, el agua y el teléfono y también otros gastos del hogar. SPANISH Centrepay Qué es Centrepay? Centrepay es la manera sencilla de pagar sus facturas y gastos. Centrepay es un servicio de pago de facturas voluntario y gratuito para clientes de Centrelink. Utilice

Más detalles

Peru 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 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 detalles

Welcome to lesson 2 of the The Spanish Cat Home learning Spanish course.

Welcome to lesson 2 of the The Spanish Cat Home learning Spanish course. Welcome to lesson 2 of the The Spanish Cat Home learning Spanish course. Bienvenidos a la lección dos. The first part of this lesson consists in this audio lesson, and then we have some grammar for you

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

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

Name: Credit Requested: $ Address: City/Zip Code: Credit Manager: E-Mail Address: Fleet Manager: E-Mail Address:

Name: Credit Requested: $ Address: City/Zip Code: Credit Manager: E-Mail Address: Fleet Manager: E-Mail Address: Name: Credit Requested: $ Address: City/Zip Code: Credit Manager: E-Mail Address: Fleet Manager: E-Mail Address: Phone Numbers: Fax Number: Business Type: Sole Proprietor Partnership Corporation How long

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

Objetivo: You will be able to You will be able to

Objetivo: You will be able to You will be able to Nombre: Fecha: Clase: Hora: Título (slide 1) Las cosas _ Capítulo 2 1 (Chapter Two, First Step) Objetivo: You will be able to You will be able to First look at the other sheet of vocabulary and listen,

Más detalles

Grow healthy. Stay healthy. Grow healthy. Stay healthy. www.startsmartforyourbaby.com PREGNANCY JOURNEY BOOK DIARIO DEL EMBARAZO

Grow healthy. Stay healthy. Grow healthy. Stay healthy. www.startsmartforyourbaby.com PREGNANCY JOURNEY BOOK DIARIO DEL EMBARAZO www.startsmartforyourbaby.com PREGNANCY JOURNEY BOOK 2012 Start Smart for Your Baby. All rights reserved. TM 2012 Start Smart for Your Baby. All rights reserved. TM DIARIO DEL EMBARAZO www.startsmartforyourbaby.com

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