FERPA grants four basic rights to parents with respect to ...



BEDFORD COUNTY PUBLIC SCHOOLS

2012-2013

MANAGEMENT OF

STUDENT SCHOLASTIC RECORDS

RESOURCES

GUIDELINES FOR THE MANAGEMENT OF THE STUDENT’S SCHOLASTIC RECORD IN THE PUBLIC SCHOOLS OF VIRGINIA (May 2004)



ENROLLMENT IN VIRGINIA PUBLIC SCHOOLS



Commonwealth of Virginia

Department of Education

P. O. Box 2120

Richmond, Virginia 23218-2120

STUDENT SCHOLASTIC RECORDS

Student scholastic records are those records that are directly related to a student, and are maintained by Bedford County Public Schools or by a party acting for Bedford County Public Schools. The content of the student scholastic record should be limited to data needed by the school to assist the student in his or her personal, social, educational, and career development.

Student scholastic records encompass all records created or collected by and maintained by Bedford County Public Schools that contain information on a student, except those records specifically exempted by law.

A student scholastic record is any information recorded in any way, including but not limited to, handwriting, print, computer media, video, or audiotape, film, microfilm, and microfiche. The term “computer media” is intended to cover any manner of maintaining information that is stored through and retrieved by a computer. Based on this definition, it is clear that scholastic records must be in some tangible form, or susceptible to reproduction in a tangible form.

A student scholastic record document can be considered “personally identifiable information” without identification of the student by name. A personal identifier includes any personal characteristics that would make the student’s identity easily traceable. For example, a student ID number, social security number, his or her initials, or other means.

EXCLUDED RECORDS

Certain records not considered scholastic records and are not maintained in the student’s education file. These include:

▪ Records that are kept in the sole possession of the maker and are used only as a personal memory aid, and are not accessible or revealed to any other person except a temporary substitute for the maker of the record;

▪ Records of a law enforcement unit of an education agency or institution;

▪ Records relating to an individual who is employed by an educational agency that are made and maintained in the normal course of business; relate exclusively to the individual in that individual’s capacity as an employee; and are not available for use for any other purpose;

▪ Records relating to an individual in attendance at the agency who is employed as a result of his or her status as a student;

▪ Records that only contain information about an individual after he or she is no longer a student at that agency or institution;

Records of a student who is 18 years of age or older, or is attending an institution of postsecondary education, that are:

← Made or maintained by a physician, psychiatrist, psychologist, or other recognized professional or paraprofessional acting in his or her professional capacity or assisting in a paraprofessional capacity;

← Made, maintained, or used in connection with treatment of the student;

← Disclosed only to individuals providing the treatment (Treatment does not include remedial educational activities or activities that are part of the program of instruction at the agency or institution.)

▪ Records maintained in the office of the school board attorney protected by the attorney-client privilege or the attorney work product doctrine.

REQUIRED RECORDS

Certain data must be collected and maintained for all students. The following data must be maintained:

▪ Record Data Disclosure Form

← BCPS must maintain a record of each request for access to and each disclosure of personally identifiable information from the scholastic records of each student. Those individuals with legitimate educational interest in the content of a student’s scholastic record are not required to sign the Record Data Disclosure Form located in the scholastic record. See Appendix A for Record Data Disclosure Form.

▪ Name and address of student

← The student’s legal name that appears on the birth certificate is considered their official name and should be printed on the student scholastic record and in the Bedford County Public School systems. A court document attesting to a change of name is required before any changes can be made to the student scholastic record. When a name change does occur, a copy of the document supporting the name change is to be maintained in the scholastic record.

▪ Birth date and birth certificate number

← An official certified copy of the child's birth record must be provided. (A photocopy of the child's birth certificate will not meet this requirement.)The principal or designee must record the official state birth number from the student’s birth record into the student’s scholastic record on the front cover in the space provided along with his/her signature, title, and date. At the time of enrollment, the child must be five years of age or reach his/her fifth birthday on or before September 30th of the school year.

← Information on obtaining a certified copy of a birth certification is available at the Virginia Department of Health website.

← If a certified copy of the child's birth record cannot be obtained, the person enrolling the child must submit a sworn statement setting forth the child's age and explaining the inability to present a certified copy of the birth record on an Age Affidavit form.

See page 9, BIRTH CERTIFICATE for additional guidance.

▪ Student ID or Social Security Number (unless waiver is granted)

← The student’s federal social security number must be provided upon enrollment or within 90 days thereafter. However, a child may not be excluded from school if a social security number is not provided. The division superintendent or a person acting on his behalf may waive this requirement if he finds that an individual is not eligible to obtain a social security number in accordance with guidelines established by the Board of Education or if the parent is unwilling to provide such number. BCPS may assign a student who receives a waiver a student identification number as a substitute for the social security number.

▪ Name and address of parent or guardian

← Addresses should be put into PowerSchool as a 911 address. To locate this go to . At the top click on Search then Search for Address, Places, Parcel Information. In pop up box click Search for an address. Click on any street name, then you can type the street name and it will search through until it finds a match with what you type or you can use the scroll bar on the right hand side. However the street address is recorded in this system is the way it should be typed into PowerSchool (example: FALLING CREEK ROAD would be FALLING CREEK RD). To see what school zone an address is in click on the road name from the directions above, then find the street number and click it. This will open a map that pinpoints the address selected. Go on the left hand side and scroll down to School Attendance click it once and then click below it High Schools, Middle Schools, or Elementary Schools, which ever applies to you. This will show a color on the map and a color beside each school. The zone that matches in color is the zone the address is located in.

← If a child has no regular, fixed residence but resides within the school division in a temporary shelter, institution, or place not ordinarily used as a residence, the school division may determine that a street address, route number, or post office box number, cannot be provided. The school division may accept an alternative form of address that it considers appropriate.

▪ Schools attended

← Schools attended should be recorded in the space provided in the student scholastic folder.

Scholastic work completed

← A Tentative Program of Studies Card should be filled out for each student (Grades 8-12) and placed in the student scholastic folder. (These forms are ordered in the summer of each school year. Please let Phyllis Pinion at the School Board Office know how many you need. This will be replaced by the Academic Career Plan in coming years for Grades 7-12.

← A report card (Grades K-8) should be printed for each student yearly and placed in the student scholastic folder.

▪ Academic transcript

← A transcript (Grades 9-12) should be printed for each student yearly and placed in the student scholastic folder.

▪ Grades and grade point average

← A report card (Grades K-8) should be printed for each student yearly and placed in the student scholastic folder. This will be a copy of report card in Grade K and 1.

← A transcript (Grades 9-12) should be printed for each student yearly and placed in the student scholastic folder.

▪ Class rank

← A transcript (Grades 9-12) should be printed for each student yearly and placed in the student scholastic folder.

▪ Type of diploma earned

← Record of diploma earned should be printed on the student’s last academic transcript and placed in student scholastic folder.

▪ Test data, to include results of Virginia State Assessment Program;

← SOL test score stickers and student performance reports should be placed on the Standards of Learning forms provided and placed within the blue SOL folder in the student scholastic record.

▪ School entrance physical examination report, immunization certificate or verification of immunizations

← The school nurse is required to examine the Comprehensive Physical Examination Form and Immunization Record to ensure its completion during enrollment. If the school nurse is absent during the time a student enrolls the records should be given to the nurse upon return for approval.

← Before any child is admitted to any public school he/she must have a Comprehensive Physical Examination by a qualified licensed physician, nurse practitioner, or physician assistant acting under the supervision of a licensed physician. A report of the examination should be recorded on a School Entrance Physical Exam Form and obtained for the school division to be placed in the student’s scholastic record. The report must indicate that the child has received the physical examination within the 12 months prior to the date the child first enters a public school (K-12). There is no grace period for obtaining Comprehensive Physical Examination.

← The Comprehensive Physical Examination is not required of any child if it violates the family’s religious beliefs and the child’s parent/guardian states in writing that the child is free from any communicable or contagious disease and there is no visual evidence of sickness. No certificate of immunization shall be required for the admission to school of any student if (1) the student or his/her parent submits an affidavit to the admitting official stating that the administration of immunizing agents conflicts with the student’s religious practices; or (2) the school has written certification from a licensed physician or a local health department that one or more of the required immunizations may be detrimental to the student’s health, indicating the specific nature and probable duration of the medical condition or circumstance that contraindicates immunization.

← Transfer students must provide records stating that a physical was completed prior to enrolling into another school in one of the following ways: a copy of the report of the physical examination or phone verification from the school he/she is transferring from with records to follow. This is also the case with immunizations. Documentation indicating that the child has received the required immunizations must be provided. Any child whose immunizations are incomplete may be admitted conditionally, but please check with current Virginia Department of Health/Department of Education or school nurse for most current guidelines.

← Press down CTRL button and click on the links below to open.

School Entrance Health Form (PDF) and Instructions (PDF)

Minimum Immunizations Requirements for Entry into Child Care and School

← The health departments of all the counties and cities must provide the physical examination for medically indigent children without charge, upon request.

▪ Notice of school status as condition of admission (a sworn statement or affirmation indicating whether the student has been previously expelled from school attendance).

See Appendix A for Affirmation/Registration Statement.

▪ Record of attendance

← Record of attendance is printed on the report card/transcript and no longer needs to be recorded in the space provided in the student scholastic folder.

▪ Student termination (graduation/withdrawal)

← Record of withdrawal should be recorded in the space provided in the student scholastic folder.

← Record of graduation should be printed on the student’s last academic transcript and placed in student scholastic folder.

In addition to the information that must be collected and maintained in each student’s education record, certain specialized information may be collected and maintained for some students. This list is not exhaustive. Other information, not listed in this section, may be collected and maintained, if necessary. The following information provides guidance about the management of certain specialized records.

SPECIAL EDUCATION RECORDS

Schools must maintain information and documentation relative to student eligibility and special education and related services in the student’s education record to provide appropriate services and for auditing purposes. This documentation includes, but is not limited to, the following information:

▪ Records of referral

▪ Reports of assessment, including educational, physiological (medical, speech, hearing, vision), psychological, sociological

▪ Permission for initial testing

▪ Permission for initial placement

▪ Permission for initial placement

▪ Summary of eligibility minutes

▪ Individualized education programs (IEPs)

▪ Student Data forms

▪ Parent notifications

Special education records are kept for active students and for five years after the student exits (graduates, withdraws, or completes a program) from Bedford County Public Schools. After five years, these records will be destroyed in compliance with the Library of Virginia Records Retention and Disposition Schedule.

CUSTODY DOCUMENTS

When a child’s parents are divorced or separated, it is important for school officials to know whether the noncustodial parent (the parent not awarded custody of the child by the court) has been restricted or prohibited by the court from exercising parental rights. There is no requirement that a school maintain complete custody or adoption papers in a student’s education record, although a school may do so. If an administrator is provided with a court order governing divorce, separation, custody or adoption, or a legally binding instrument that denies a parent access to a child or the child’s records, the administrator may instead make a notation in the student’s record referencing the written evidence that was presented and its date. In this way, the record will contain only information necessary for school officials to protect a student and comply with the court order. The form below can be used to transcribe necessary information.

See Appendix A for Custody Information Form.

DISCIPLINARY RECORDS

Disciplinary records are records that are directly related to a student and any disciplinary action taken against that student for violation of school rules or policies occurring on school property or at school-sponsored events. Every notice of adjudication or conviction received by a local superintendent, and information contained in the notice, shall be maintained by the superintendent and by any other person to whom he disseminates it, separately from all other records concerning the student. However, if the school administrators or the school board takes disciplinary action against a student based upon an incident (on school property or during a school sponsored activity), formed the basis for the adjudication or conviction, the notice shall become a part of a student’s disciplinary record. Disciplinary records must be maintained as part of a student’s education record. FERPA requires schools to transfer any and all education records, including disciplinary records, on a student transferring to another school.

HOMESCHOOL RECORDS

Home schooling means instruction of a child or children by a parent/guardian or other person having control of such child or children, as an alternative to attendance in public or private school. The records of a home-schooled child’s educational program, including courses taken and grades achieved in these courses, and the results of annual evaluations which may include the results of standardized tests need to be reported to the division superintendent or designated education official within the school division in which the child is being home-schooled.

← Press down CTRL button and click on the link below to open or see Appendix A.

Notice of Intent to Provide Home Instruction

SCHOOL STATUS

When enrolling a student in Bedford County Public Schools from another school division, the parent/guardian is required to provide a sworn statement or affirmation indicating whether the student has been expelled from school attendance at a private school or in a public school division of the of the commonwealth or in another state for an offense in violation of school board policies relating to weapons, alcohol or drugs, or for the willful infliction of injury to another person.

SOCIAL SECURITY NUMBER

Each student is required to present a federal social security number within ninety days of his/her enrollment. Students whose parents are unable or unwilling to provide a social security number for them will be issued a student identification number by the superintendent/designee. No child may be excluded from school for failure to provide a social security number.

← Press down CTRL button and click on the link below to open.

Code of Virginia 22.1-260

BIRTH CERTIFICATE

No student shall be admitted for the first time to any public school in any school division unless the person enrolling the student presents, upon admission, an original certified copy of the student’s birth certificate, and that the principal or designee should record the official state birth number from the student’s birth certificate onto the student’s scholastic record. If the student later enrolls in another public school in Virginia, either in the same school division or a different school division, the parent does not have to provide the birth certificate again. The school enrolling the student can obtain the birth certificate number or a copy of the birth certificate from the releasing school.  If an original certified copy of the child’s birth record cannot be obtained, the person enrolling the child must submit a notarized sworn statement/affidavit stating the child’s age and explaining the inability to present an original certified copy of the birth certificate. See Appendix A for Age Affidavit.

The person enrolling needs to notify the records designee if it is not their self. The records designee is responsible for rechecking records without birth certificates and following up with parents to bring in. If a parent does not provide a birth certificate, law enforcement should be contacted. For all we know the student could be kidnapped, etc. The only times an affidavit would be the only proof would be for a student with a visa that is here for a short time or an immigrant that has no paperwork. The birth certificate you make a copy from shouldn’t be a copy itself, a verification of birth, or a confirmation of birth. It needs to be the original certified birth certificate from the Department of Vital Records.

← Press down CTRL button and click on the link below to open.

Code of Virginia 23-2.1:2

PROOF OF CITIZENSHIP

Bedford County Public Schools is not permitted to inquire into a prospective student’s citizenship or visa status to enroll that student in school. Bedford County Public Schools shall accept students who meet the residency requirements of the Code of Virginia and may not deny a free public education to undocumented school-age children who reside within their jurisdictions because they do not hold valid United States citizenship or a student visa.

HOMELESS STUDENT

A student is considered to be homeless when he/she lacks a fixed, regular, and adequate permanent residence. Bedford County Public Schools must immediately enroll a homeless student even if required documents, such as birth certificate, school records, medical records, proof of residency, etc. cannot be provided. Schools must obtain records for homeless students from the previous school attended, but not required before enrollment. All questions pertaining to homeless students should be directed to the Instruction Department, Mac Duis, Director of Instruction.

MISSING CHILDREN

When notified by a local law enforcement agency that a child is missing, the principal or his/her designee should update the student’s scholastic record to reflect that the child has been reported missing. Upon receiving a request from any school or person for copies of the scholastic records of any child who has been reported by a local law-enforcement agency to be missing, the school being requested to transfer the records should immediately notify the law enforcement agency which provided the report to the school of the child’s disappearance of the location of the school or person requesting the scholastic records of the child.

PARENTS

FERPA defines “parent” as a parent of a student and includes a natural parent/guardian or an individual acting as a parent in the absence of a parent or guardian. Bedford County Public Schools will consider an individual to be an acting parent only in extraordinary circumstances.

▪ DIVORCE OR SEPARATION

Bedford County Public Schools is obligated to give full rights to either parent, unless

Bedford County Public Schools has been provided evidence that there is a court order, or

legally binding document relating to divorce, separation, or custody that specifically revokes

these rights.

▪ STEPPARENTS

A stepparent has the same rights as natural parents, provided that the stepparent is present

on a daily basis with the natural parent and child, and the other parent is absent from the

home. On the other hand, a stepparent who is not present on a daily basis in the home of the

child does not have right with respect to that child’s scholastic records.

▪ RIGHTS AFTER AGE 18

Parents lose their rights when their child turns 18, or starts attending a postsecondary

institution, if that happens first. The student is referred to as an “eligible student”.

However, a school may disclose the scholastic records to the parents of an eligible student, who is 18 years of age or older, who is considered a dependent student under Section 152 of the Internal Revenue Code of 1954 without the consent of the eligible student. A parent of a child with a disability who is 18 may retain his/her rights provided that the child has been determined to be legally incompetent or legally incapacitated.

ACCESS RIGHTS

The superintendent or his/her designee is responsible for the collection, maintenance, security, use, disclosure, and content of the scholastic record at the division level. The same is true at the school level that the school’s principal or his/her designee is responsible.

Generally, schools must have written permission from the parent or eligible student before releasing any information from a student’s education record; however, the law allows schools to disclose educational records, without consent, to the following:

▪ To school officials within the agency, including teachers, whom the agency has determined to have legitimate educational interests;

← See page 16, RECORD CONFIDENTIALITY for additional guidance.

▪ To officials of another school, school system, or institution of postsecondary education where the student intends to enroll;

← It is important for a school to receive the student’s complete scholastic record when the student enrolls as soon as they are requested. Original records are not transferred outside of Bedford County Public Schools. Copies are provided to other school divisions requesting records. See Appendix A for Authorization for Confidential Release and Exchange of Education and Health Records Form.

▪ To authorized representatives of the Comptroller General of the United States, the Attorney General of the United States, the U. S. Secretary of Education, or state or local educational authorities;

▪ To state and local officials or authorities to whom the information is allowed to be reported or disclosed pursuant to a state statute adopted before November 19, 1974, if the allowed reporting or disclosure concerns the juvenile justice system and the system’s ability to effectively serve the student whose records are released;

▪ To a party when the disclosure is in connection with financial aid for which the student has applied or which the student has received, if the information is necessary to determine eligibility for the aid, the amount of the aid, the conditions of the aid, or enforce the terms and conditions of the aid (“Financial aid” means payment of funds to an individual, or a payment in kind of tangible or intangible property to an individual, that is conditioned on the individual’s attendance at an educational agency or institution.)

▪ To organizations conducting studies for, or on behalf of, educational agencies or institutions to develop, validate, or administer predictive tests; administer student-aid programs; or improve instruction. The agency or institution may disclose information only if the study is conducted in a manner that does not permit personal identification of parents and students by individuals other than representatives of the organizations, and the information is destroyed when it is no longer needed for the purposes for which the study was conducted;

▪ To accrediting organizations to carry out their accrediting functions;

▪ To parents of a dependent student as defined in Section 152 of the Internal Revenue Code of 1986;

▪ To a party to comply with a judicial order or lawfully issued subpoena;

▪ The educational agency or institution may disclose information only if the agency or institution makes a reasonable effort to notify the parent or eligible student of the order or subpoena in advance of compliance, so that the parent or eligible student may seek protective action unless the disclosure is in compliance with a federal grand jury subpoena and the court has ordered that the existence or the contents of the subpoena or the information furnished in response to the subpoena not be disclosed;

▪ To a court, if the educational agency has initiated legal action against a parent or student. The disclosure is of scholastic records that are relevant for the educational agency to proceed with the legal action as plaintiff;

▪ To a court, if a parent or eligible student initiates legal action against an educational agency; the disclosure involves scholastic records that are relevant for the educational agency to defend itself;

▪ To a party that has requested personally identifiable information needed in connection with a health or safety emergency;

← The knowledge of such information must be determined necessary to protect the health and safety of a student or other persons.

▪ To a party that has requested information the educational agency has designated as “directory information”;

← Schools may disclose, without consent, “directory information” such as a student’s name, address, telephone number, date and place of birth, honors and awards, and dates of attendance. However, the school must inform parents and eligible students about the types of information the school considers directory information. Schools are required to allow parents or eligible students a “reasonable amount of time” to request that the schools not disclose directory information about them. The high schools will provide an “opt-out” form if requested. Parents/eligible students must notify the school in writing if they do not wish to have any part or all information classified as directory information concerning their child or self (if 18 years of age or older) released without your prior consent. Directory information is not generally considered harmful or an invasion of privacy if disclosed. See Appendix A for Opt-Out Form.

▪ To the parent of a student who is not an eligible student or to the student;

▪ To a victim of an alleged perpetrator of a crime of violence or a non-forcible sex offense. The disclosure may only include the final results of the disciplinary proceeding conducted by the institution on postsecondary education with respect to that alleged crime or offense.

All parties that the law allows disclosure to are to provide documentation of disclosure on the student’s Record Data Disclosure Form, which is in the student scholastic record. The form identifies the student; specifies legitimate interest in requesting/obtaining information; identifies the party and/or additional parties to whom the receiving party may disclose the information and their legitimate interests; and an approval signature. An approval signature can be a school principal or his/her record’s designee. This form is not to be used by Bedford County Public Schools personnel. School officials are to use the student scholastic record sign in/out sheets located in your records area.

Bedford County Public Schools may disclose personally identifiable information from student scholastic record only on the condition that the party to whom the information is disclosed will not “re-disclose” the information to any other party without documentation of prior consent of the parent or eligible student. The third party who receives the information may use the information only for the purposes for which the disclosure was made. If Bedford County Public Schools determines that the third party improperly disclosed information from scholastic records, BCPS may not allow that third party access to personally identifiable information for at least five years.

Bedford County Public Schools will not release student scholastic records to any party unless the principal or his/her record’s designee authorizes access. Proper identification from any person requesting access may be required such as a driver’s license or military identification card. In other circumstances where school personnel are not convinced of a person’s identity custody orders and birth certificates may provide verification.

Parents and eligible students may provide written consent for student record disclosures other than those allowed by law. A written consent must be a signed document that identifies the student; specifies the records to be disclosed; states the purpose of the disclosure; and identifies the party or class of parties to whom the disclosure may be made. If the written consent does not identify specific records to be disclosed, access will be given to all records of the student.

PARENTAL RIGHTS

Bedford County Public Schools is required to notify parents and eligible students annually of their rights under the Family Educational Right and Privacy Act (FERPA). The annual notice may be made by any means that is likely to inform parents and eligible students of their rights, including a special letter, student handbook, bulletin, newspaper, or by any other means that will assure notification to the student’s home. Bedford County Public Schools is required to effectively notify parents and students who have a primary or home language other than English, Schools should consult with parents and eligible students in determining how best to provide them with this notice. Bedford County Public Schools is also required to provide notification to disabled students in alternative formats such as audiotape, Braille, computer disk, or large print, as appropriate.

Under FERPA, Bedford County Public Schools shall provide rights regarding inspection and review of the student’s scholastic records. These rights transfer to the student, or former student, upon reaching the age of 18 or attending any school beyond high school level. Students and former students to whom the rights have transferred are called “eligible students.” These rights are as follows:

▪ The right to inspect and review the scholastic records of their children. When a scholastic record pertains to more than one child, parents have the right to inspect and review, or be informed only on that part of the record or document that relates to their child. Eligible students also have a right to inspect and review their scholastic records. Schools must comply with a request to inspect or review a child’s scholastic record within a reasonable time but not to exceed 45 days.

Parents or eligible students should submit to the School principal or his/her designee a written request that identifies the record(s) they wish to inspect. The school official will make arrangements for access and notify the parent or eligible student of the time and place where the record(s) may be inspected.

▪ The right to inspect or review scholastic records of a child with a disability without unnecessary delay and before any meeting regarding an IEP, or any hearing as required by Individuals with Disabilities Education Act (IDEA). The IDEA also allows the parent to have a representative inspect and review the records.

▪ The right to (1) a hearing to challenge the content of scholastic records to insure they are not inaccurate, misleading, or otherwise in violation of the privacy rights of students (2) the right to have an opportunity to correct or delete inaccurate, misleading, or otherwise inappropriate data, and (3) the right to insert a written explanation regarding the contents of the records.

Parents or eligible students may ask the school to amend a record(s) that they believe is inaccurate, misleading, or otherwise in violation of the privacy rights of students. They should submit a written request that clearly identifies the part(s) of the record(s) they want changed and specify their reasoning to the School principal or his/her designee. If the school decides not to amend the record as requested by the parent or eligible student, the School official will notify the parent or eligible student of the decision and inform them of his/her right to a hearing regarding the request for amendment.

The following are the minimum requirements for a hearing:

← The hearing must be held within a reasonable time after the request is received;

← The school must provide the parent or eligible student with notice of the date, time, and place within a reasonable time in advance of the hearing;

← The hearing may be conducted by any party, including an official of the school division who does not have a direct interest in the outcome of the hearing;

← The parent or eligible student must be afforded a full and fair opportunity to present evidence relevant to the issues. The parent or eligible student may, at their own expense, be assisted by another person, including an attorney;

← The school must make its decision in writing within a reasonable time after the conclusion of the hearing; and

← The decision of the school must be based solely on the evidence presented at the hearing and must include a summary of the evidence and the reasons for the decision.

▪ The right to annual public notice of parent rights and designated categories of directory information and a reasonable time, or during a time period not to exceed 45 days, to refuse to allow the release of directory information without prior consent.

▪ The right to copies of scholastic records if circumstances effectively prevent the parent or eligible student from exercising the right to inspect and review the student’s scholastic records, e.g., parents who live out side of the school district or parents with a serious illness. In addition, parents are entitled to receive copies, upon request, of records that are disclosed to another school that their child is attending or plans to attend. Local education agencies may need to make copies of scholastic records available to allow inspection when scholastic records are electronically maintained.

Bedford County Public Schools may charge a copy fee unless imposition of such a charge would prevent a parent from exercising his or her right to inspect and review the scholastic records. The fee may include costs associated with reproduction, secretarial or administrative time, and postage. Please see below for a listing of charges. Bedford County Public Schools may not charge a fee to search for and retrieve the scholastic records of a student, or for a copy of a current individualized education plan (IEP).

▪ The right to a response to reasonable requests for explanations and interpretations of the scholastic records.

▪ The right to file a complaint with the U. S. Department of Education, at the address below, concerning alleged failures by the school to comply with the requirements of FERPA. Schools are required to notify parents and eligible students annually of their rights under FERPA.

Family Policy Compliance Office

U.S. Department of Education, 400

Maryland Avenue, SW.

Washington, DC 20202-4605

COPIES OF STUDENT SCHOLASTIC RECORDS

Bedford County Public Schools will not provide a parent or eligible student a copy of the entire student’s scholastic record unless failure to do so would effectively prevent the parent or eligible student from exercising the right to inspect and review the records.

FEES FOR STUDENT RECORDS

Bedford County Public Schools charges a processing fee of $5 per document for all agency and former student record requests which include Graduation/GED verification, official/unofficial transcript and proof of immunization. Current students may obtain up to five transcripts each year at no charge with each subsequent transcript being $5 each. The fee for copies of all other student record documents will be 25¢ per page.

Bedford County Public Schools shall not charge a fee for copying an Individualized Education Plan (IEP) or for a copy of the verbatim record of a hearing conducted in accordance with the State Board of Education's Regulations Governing Special Education Programs for Children with Disabilities in Virginia.

← Press down CTRL button and click on the link below to open.

Student Records – Bedford County Public Schools Policy JO

RECORD CONFIDENTIALITY

An Access to Records sheet will be sent to principals and records designees at the beginning of each school year. This document states who is allowed to access student scholastic records along with the school(s) they have access to. A copy of this document should be posted on the outside of each records room. The principal/records designee(s) are responsible for the collection, maintenance, security, use, disclosure, and content of the scholastic record. The designee or the school principal is the only personnel who should have keys to file rooms used for student records. If authorized personnel need information from a scholastic record they are to have the principal/designee to unlock the records room.

A Student Scholastic Record Sign-Out sheet is provided to schools to track school division faculty/staff that are permitted to access student records. By signing this sheet authorized personnel agree that the student record and any information it contains will be used only for educational purposes concerning the student. All information is confidential and BCPS has a responsibility to protect the rights and privacy of the student and his/her parents. It is not allowed for any individual to remove, add, or alter any part of a student record that is not specific to your job duties. All other modifications must be approved by the Records Officer, Melissa Sexton at the School Board Office. All records should be checked out and viewed within the school and are not to be taken off the premises. They should also be viewed in a way that ensures the protection of confidentiality so information should be viewed and accessible only to the person who checked out the record unless it is for an IEP meeting or IDEA hearing where other individuals such as a parent/guardian or a parent’s representative have the right to inspect also. All records need to be returned the same day they are checked out to the principal or the records designee. This sheet is subject to internal audit for compliance. See Appendix A for Student Scholastic Record Sign-Out sheet.

PROTECTION OF PUPIL RIGHTS AMENDMENT (PPRA)

The Protection of Pupil Rights Amendment (PPRA) is a federal law that affords certain rights to parents of minor students with regard to surveys that ask questions of a personal nature.

PPRA provides:

▪ Schools and contractors make instructional materials available for inspection by parents if those materials will be used in connection with any U.S. Department of Education funded survey, analysis, or evaluation in which their children participate

▪ Schools and contractors obtain prior written parental consent before minor students are required to participate in any U.S. Department of Education funded survey, analysis, or evaluation that reveals information concerning:

← political affiliations or beliefs of a student or a student’s parents;

← mental and psychological problems of the student or the student’s family;

← sex behavior or attitudes;

← illegal, anti-social, self-incriminating, or demeaning behavior;

← critical appraisals of other individuals with whom respondents have close

← family relationships;

← legally recognized privileged or analogous relationships, such as those of lawyers, physicians, and ministers;

← religious practices, affiliations, or beliefs of the students or student’s parents; or

← income (other than required by law to determine eligibility for participation in a program or that receiving financial assistance under such programs).

Schools are required to develop and adopt policies – in conjunction with parents- regarding the following:

1. The right of parents to inspect, upon request, a survey created by a third party

before the survey is administered or distributed by a school to students;

2. Arrangements to protect student privacy in the event of the administration of a

survey to students, including the right of parents to inspect, upon request, the

survey, if the survey contains one or more of the same eight items as noted previously;

3. The right of parents to inspect, upon request, any instructional material used as part

of the educational curriculum for students;

4. The administration of physical examinations or screenings that the school may

administer to students;

5. The collection, disclosure, or use of personal information collected from students for

the purpose of marketing or selling, or otherwise providing the information to others

for that purpose; and

6. The right of parents to inspect, upon request, any instrument used in the collection

of information, as described in number 5.

The educational agency shall offer an opportunity for parents to opt out of (remove their child) from participation in the following activities:

▪ Activities involving the collection, disclosure, or use of personal information collected from students for the purpose of marketing or for selling that information, or otherwise providing that information to others for that purpose;

▪ The administration of any third party (non-Department of Education funded) survey containing one or more of the above described eight items of information;

▪ Any nonemergency, invasive physical examination or screening that is: 1) required as a condition of attendance; 2) administered by the school and scheduled by the school in advance; and not necessary to protect the immediate health and safety of the student, or of other students;

▪ In the notification, the educational agency shall inform parents of the specific or approximate dates during the school year when these activities are scheduled.

PPRA requirements do not apply to the collection, disclosure, or use of personal information collected from students for the exclusive purpose of developing, evaluating, or providing educational products or services for, or to, students or educational institutions, such as the following:

▪ College or other postsecondary education recruitment, or military recruitment;

▪ Book clubs, magazines, and programs providing access to low -cost literacy products;

▪ Curriculum and instructional materials used by elementary and secondary schools;

▪ Tests and assessments used by elementary and secondary schools to provide cognitive, evaluative, diagnostic, clinical, aptitude, or achievement information about students;

▪ The sale by students of products or services to raise funds for school-related or education-related activities;

▪ Student recognition programs.

The rights provided to parents under PPRA transfer to the student when the student becomes 18 years old or is an emancipated minor under applicable state law.

Parents or eligible students should first inform the school principal and/or the division superintendent of the complaint and work with the school to resolve the matter. If not satisfied with the results, a parent or eligible student may file a written complaint regarding an alleged violation with the Family Policy Compliance Office (FPCO).

Family Policy Compliance Office

U.S. Department of Education, 400

Maryland Avenue, SW.

Washington, DC 20202-4605

▪ A complaint must contain the specific allegations of fact giving reasonable cause to believe that a violation of act occurred.

▪ The FPCO investigates each timely complaint to determine whether the educational agency or institution has failed to comply with the provision of the act.

▪ A timely complaint is defined as an allegation of a violation or of the date that the complainant knew or reasonably should have known of the alleged violation.

▪ The FPCO may extend the time limit in this section for good cause shown.

The responsibilities of Family Policy Compliance Office (FPCO) in the enforcement process are as follows:

▪ The FPCO reviews the complaint and response and may permit the parties to submit further written or oral arguments or information.

▪ Following its investigation, the FPCO provides to the complainant and the educational agency or institution written notice of its findings and the basis for its findings.

▪ If the FPCO finds that the educational agency has not complied with the act, it provides a statement of the specific steps that the agency or institution must take to comply, and provides a reasonable period of time, given all of the circumstances of the case, during which the educational agency or institution may comply voluntarily.

APPENDIX A

Student Record Forms/Directions

Records Management Checklist Page 21&22

Record Data Disclosure Form Page 23

Enrollment Checklist Page 24&25

Affirmation/Registration Statement Page 26

Custody Information Page 27

Authorization for Confidential Release and Exchange of Education and Health Records Page 28

Notice of Intent to Provide Home Instruction Page 29

Age Affidavit Page 30

Opt-Out Form Page 31

Student Scholastic Record Sign-Out Sheet Page 32

RECORDS MANAGEMENT CHECKLIST

The Student Scholastic Record should contain this information. Records in the Student Scholastic Record should be maintained in the same order as the checklist. This checklist should be filed in the FRONT.

1. Record Data Disclosure Form

▪ Beginning 2011-2012 will be located on 3rd page of actual student scholastic folder

2. Enrollment Checklist

3. Student Information Form(s) (Enrollment Form, Foster Care Information Enrollment Form,

Re-Identification Form, Residency Validation Forms, transfer forms, School Verification forms)

4. Legal Documents (court orders, custody papers, Age Affidavit, etc.)

5. Tentative Program of Studies Card

▪ Academic Career Plan (Grades 7-12) will begin to replace Tentative Program of Studies card

6. Copy of End of Year Report Card (Grades K-8) /End of Year Transcript (Grades 9-12)

▪ Summer School Grade Reports and report cards from other school districts

7. SOL Folder

▪ SOL Test Data Card (A separate card for SOL, Virginia Alternative/Alternative Assessment, English Language Proficiency test score labels)

▪ SOL Student Performance Report

▪ Other SOL Specific Data (SOL remediation documents, modification sheets, etc.)

8. Standardized Test Card (Stanford 10, OLSAT, Naglieri, PSAT, SAT, ACT, AP, etc.)

▪ Standardized Test Profile Sheets

9. Cumulative Health Record Card (School Entrance Physical Examination, Immunization certificate or

other verification of immunizations, Cumulative Physical Fitness Card, Vision & Hearing Screenings,

medical forms, health care plans, copy of birth certificate, copy of Social Security card)

10. Miscellaneous (Opt-Out for Directory Information Forms, Affirmation/Registration Statement,

Authorization for Confidential Release and Exchange of Education and Health Records forms,

Photo Information Release form–last year enrolled, Secondary School Activity and Service Record, letters to

parents, discipline reports, etc.)

11. Progress Monitoring Folder (formative assessment data for use in remediation and RTI efforts including PALS

end of year student summary report, QRI, QuickChecks or summary data for interventions, IStation, STAR,

Fraction Nation, etc.)

12. Student Scholastic Record Insert (All Special Education forms, SCT, 504, Gifted, and LEP plans)

▪ File all records in reverse chronology (most recent data filed in front of the data group).

▪ Documents from previously attended school divisions should be incorporated into the Bedford County Student Scholastic Record as items in the appropriate categories listed above.

▪ Do not include staples, paper clips, and/or sticky notes in the record.

▪ All information required on actual Student Scholastic Record should be updated YEARLY if it is specified to be written in pencil or is annually recurring. This includes: Parent/Guardian’s address, phone number, and occupation; family doctor information; attendance record; record of promotion in grades K-8; transfer record; if a Student Scholastic Record Insert is added the date created; and record of withdrawal without entering a school/GED program.

BACK OF THIS FORM SHOULD BE FILLED IN YEARLY BY AUTHORIZED PERSONNEL

No records are to be purged without being requested by the current Records Officer.

Currently the Record’s Officer is Melissa Sexton at School Board Office.

Student Scholastic Record Yearly Update

Student Name:

|Date |Staff Member Completing |Title of Staff Member |School |

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ENROLLMENT CHECKLIST

PRINTED FULL LEGAL NAME OF STUDENT NAME OF SCHOOL ENROLLING DATE

PRINTED NAME OF SCHOOL OFFICIAL COMPLETING/TITLE SIGNATURE OF SCHOOL OFFICIAL COMPLETING

Please print date in space provided when each item is completed.

1. Emergency Information Card

2. Signed Consent for Release of Education Records/Data

3. BCPS Enrollment Form

4. Foster Care Information Enrollment Form (if applicable use in place of BCPS Enrollment Form)

5. Affirmation/Registration Statement

6. Residency Validation Form

7. Commonwealth of Virginia School Health Form (immunizations and physical)

▪ Immunizations must be approved by school nurse during enrollment unless nurse is absent.

▪ Put health records of enrolling students together and give to nurse for approval upon return from absence.

▪ Only school nurse or county nurse coordinator can approve health record.

▪ Comprehensive Physical Exam must be within 12 months to date child enters a public school Grades K-12.

8. Medical Forms

Check all that apply: Physician/Parent Authorization to Administer Medication (All Schools)

Providing and Administering Non-Aspirin Pain Relievers (Middle and High Only) and

Oral Antihistamines in School Clinics

Providing and Administering Oral Antihistamines in School Clinics (Elementary)

▪ Inform parent that other medical forms for specific allergies/health concerns are available from nurse

9. Birth Certificate

▪ Certified copy of birth certificate when a student initially enrolls in a public school in Virginia

▪ Record official birth certificate number on front cover of scholastic folder; sign, date, and print title on folder

▪ A copy of birth certificate may be placed in scholastic folder inside the health record.

▪ Notarized Affidavit is to be filled out only if a birth certificate cannot be obtained for some legitimate reason

10. Social Security Card

▪ Provide within 90 days of enrolling date listed above.

▪ Record official birth certificate number on front cover of scholastic folder; sign, date, and print title on folder

▪ Parents who are unable or unwilling to provide a SSN may assign Student ID #

▪ A copy of social security card may be placed in scholastic folder inside the health record.

11. Legal Documents (if applicable; ex: court orders, custody papers)

ENROLLMENT CHECKLIST CONTINUATION

12. Free/Reduced Lunch Form (if applicable)

13. Opt-Out Forms (offer to parent)

Check all that apply: Family Life Personal/Social Counseling Military Recruiters Directory Info

Institutions of Higher Education Directory Information

14. Code of Student Conduct

15. Agenda (if applicable; meaning if it is your job responsibility at your school)

16. School calendar (if not part of Agenda)

▪ Print off of BCPS webpage if parent would like

17. Lunch Menu

▪ Print off of BCPS webpage if parent would like

18. Student Bus Pass (if applicable)

19. Student Accident Insurance Information

20. Parent Portal Information

▪ Print off of BCPS webpage

▪ Give PowerSchool school contact person information to parent for any questions/needs.

21. Supply List (Elementary & Middle Schools)

22. Grade Level Course Selection Form (if applicable; meaning if it is your job responsibility at your school)

SCHOOL SPECIFIC FORMS

23.

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BEDFORD COUNTY PUBLIC SCHOOLS

RECORD DATA DISCLOSURE FORM

STUDENT’S NAME BIRTH DATE STUDENT ID

LAST FIRST MIDDLE MONTH DAY YEAR RECORD NUMBER

|NAME OF PARTIES WHO HAVE REQUESTED OR RECEIVED PERSONALLY |DATE PARTY REQUESTED OR OBTAINED |PARTY’S LEGITIMATE INTEREST IN REQUESTING OR OBTAINING INFORMATION |SIGNATURE AND TITLE OF SCHOOL OFFICIAL |

|IDENTIFIABLE INFORMATION |INFORMATION | |APPROVING |

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RECORD DATA DISCLOSURE FORM IS TO BE RETAINED PERMANENTLY WITH THE STUDENT’S SCHOLASTIC RECORD.

THIS FORM NOT TO BE USED FOR SCHOOL STAFF! USE THE STUDENT SCHOLASTIC RECORD SIGN-OUT SHEET IN RECORD’S AREA.

Note: If a representative of Bedford County Public Schools discloses information with the understanding that the party receiving the information may make further disclosures on behalf of BCPS, if the disclosures meet the requirements of FERPA, the record of the disclosure must include the names of the additional parties to whom the receiving party may disclose the information and the legitimate interests.

AFFIRMATION/REGISTRATION STATEMENT

Virginia law requires that, prior to admission to any public school of the Commonwealth, a school board shall require the parent, guardian, or other person having control or charge of a child of school age to provide, upon registration, a sworn statement of affirmation indicating whether the student has been expelled from school attendance at a private school or in a public school division of the Commonwealth or in another state for an offense in violation of school board policies relating to weapons, alcohol or drugs, or for the willful infliction of injury to another person. Any person making a materially false statement or affirmation shall be guilty upon conviction of a Class 3 misdemeanor. This registration document shall be maintained as part of the student’s scholastic record. (Code of Virginia § 22.1-3.2)

PLEASE COMPLETE AND CHECK THE BOX RELEVANT TO STUDENT

I affirm that

PRINTED LEGAL NAME OF STUDENT

HAS NOT

HAS

been expelled from school attendance at a private school or public school in Virginia or another state for an offense in violation of school board policies relating to weapons, alcohol or drugs, or for the willful infliction of injury to another person.

PRINTED LEGAL NAME OF PARENT/GUARDIAN/LEGAL CUSTODIAN OF STUDENT

SIGNATURE OF PARENT/GUARDIAN/LEGAL CUSTODIAN OF STUDENT DATE

CUSTODY INFORMATION

(Fill in relevant information)

Student’s Full Name: DOB:

Father’s Name: Mother’s Name:

By decree of the State of , County of

on , Clerk of Court ,

DATE TYPE OF COURT CLERK’S NAME

recorded and affixed seal to the custody order given by Judge .

JUDGE’S NAME

, mother, father, other: is named legal guardian.

NAME OF RESIDENTIAL PARENT/GUARDIAN CIRCLE ONE CHOICE

He/she has sole custody, joint custody with .

CHECK CUSTODY SITUATION THAT APPLIES NAME OF JOINT LEGAL GUARDIAN

The non-residential parent, , has the following visitation rights:

NAME OF NON-RESIDENTIAL PARENT

With the following restrictions:

Any additional information:

This information was copied for case number by ,

STAFF MEMBER COMPLETING

at School in Bedford County, Virginia

JOB TITLE OF STAFF MEMBER NAME OF SCHOOL

on .

DATE

AUTHORIZATION FOR CONFIDENTIAL RELEASE AND EXCHANGE

OF EDUCATION AND HEALTH RECORDS

|LEGAL FULL NAME OF STUDENT/PATIENT |STUDENT/PATIENT DATE OF BIRTH |

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|SCHOOL/AGENCY/PERSON RELEASING RECORDS |ADDRESS |PHONE NUMBER |FAX NUMBER |

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|OFFICIAL REQUESTING RECORDS/TITLE |ADDRESS |PHONE NUMBER |FAX NUMBER |

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I request release or exchange of the following information on my child or ward to the official stated above for the purpose of:

.

(CHECK ALL THAT APPLY:

( Official Scholastic Record (includes: student name/address, parent’s names/addresses, certified copy of birth

certificate (Code of Virginia § 22.1-3.1C) or birth certificate number as recorded by another VA public school, birth date,

grade level completed, class standing, attendance record, Student Testing Identifier (STI), extracurricular activities,

citizenship, if other than the United States, etc.)

( Scholastic grades (historical and withdrawal grades with grading scale) ( Discipline record

( Group and individual intelligence, achievement, aptitude and interest test scores

(includes: SOL, AP, PSAT, SAT, ACT, Stanford 10, Olsat, Naglieri, etc.)

( Limited English Proficient (LEP) records ( Talented and Gifted (TAG) records

( 504 records, Individualized Education Program (IEP), latest eligibility minutes, eligibility summary, SCT information,

evaluation reports and functional behavioral assessments.

( All health records listed below:

( Physical and immunization records with dates signed by doctor or school nurse ( Lab reports

( Medical diagnosis ( Doctors orders ( Medical Care Plan ( Mental Health/Psychiatric

( Discharge summary ( Audiological/Vision ( Speech reports ( Social/Cultural

( Psychological reports ( Fitness data

( Others (please specify):

This authorization is valid for one year unless specified otherwise. It will expire on .

I understand that I may withdraw this authorization by submitting written notice to the school/agency/person releasing records stated above. I understand that health records, once received by the school district, may no longer be protected by HIPPA, but they will become education records protect by the Family Educational Rights and Privacy Act (FERPA). I have the right to request a hearing to challenge the content and accuracy of these records on the student/patient named above.

SIGNATURE OF PARENT/GUARDIAN/LEGAL CUSTODIAN OR ELIGIBLE STUDENT DATE

SIGNATURE OF SCHOOL OFFICIAL COMPLETING

NOTICE OF INTENT TO PROVIDE HOME INSTRUCTION

I am providing notice of my intention to provide home instruction for the child(ren) listed below as provided for by § 22.1-254 of the Code of Virginia in lieu of having them attend school.

School Year: 2012 – 2013

|NAME(S) OF CHILD(REN) |DATE OF BIRTH |GRADE LEVEL |SCHOOL CHILD WOULD ATTEND IF IN PUBLIC SCHOOL |

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I wish to be recognized as eligible to provide home instruction by selecting the option indicated below.

Check one below:

( I have a high school diploma or a higher credential. (Attach copy of the documentation that shows this.)

( I have the qualifications prescribed by the Board of Education for a teacher. (Attach copy of a teaching license or a

statement to this effect from the Virginia Department of Education.)

( I have provided a program of study or curriculum which is to be delivered through a correspondence course or a

distance learning program or in some other manner. (Attach a notice of acceptance or other evidence of enrollment

showing the name and address of the school, the courses in which each child is enrolled, and a description of a program of

study or curriculum you will use for the home instruction. If you choose to provide a program of study or curriculum in

some other manner as specified in the Code, you must submit a copy of that program of study or curriculum to the school

division.)

( I have attached to this notice a statement which describes why I am able to provide an adequate

education for my child(ren).

As prescribed in § 22.1-254.1 of the Code of Virginia, I have included or will provide the school division with a description of the curriculum and evidence of having met one of the above criteria along with this Notice of Intent by August 15 of each year. If I begin home instruction after the school year has started, I will submit this Notice of Intent as soon as practicable and comply with the other requirements within 30 days of the Notice of Intent to the school division.

I understand that by August 1 following this school year, I must provide evidence of educational achievement as prescribed in § 22.1-254.1 of the Code of Virginia, which defines the requirements for home instruction. Any nationally-normed standardized achievement test may be used as evidence of progress (i.e. Stanford 10, ITBS, CAT). I am required to send a copy of current and previous year report cards for first time registration and each year after while my child(ren) receive home instruction.

( Pursuant to § 22.1-254.B.1 of the Code of Virginia, I am requesting that my child(ren) be excused from attendance at school

by reason of bona fide religious training or belief. (Attach a statement affirming your religious training or beliefs.)

UPON COMPLETION OF HOME SCHOOL CURRICULUM, PLEASE NOTIFY OUR OFFICE OF GRADUATION DATE.

I hereby certify that I am the parent or guardian of the child(ren) listed above.

Parent/Guardian Printed Name

Parent/Guardian Signature Date

Address

Home Phone Number Work Phone Number

AFFIDAVIT

, being first duly sworn upon oath, based upon his/her personal knowledge, answers the following questions as noted in his/her handwriting on this page, which are propounded by authorized officials of the Bedford County Public School Division concerning a student’s identity and age requesting enrollment as a student within the division in accordance with Section 22.1-3.1 of the Code of Virginia.

1. What is your name?

2. Have you been advised by an official of the school division, and do you understand that you are required

to answer the questions contained in this Affidavit as a condition to your enrollment and admission of a

student into the Bedford County Division because of your inability to supply the division with a certified

copy of a student’s birth record?

3. Do you understand that giving a false or otherwise untrue answer to any of the questions in this Affidavit

could result in a criminal charge of perjury being brought against you?

4. Do you understand that when a question in this Affidavit asks if you have knowledge of or if you know of

an instance or situation, it means that you are expected to relate any knowledge you have about the

incident, whether it be personal knowledge or information received from other people, and to relate the

source of your knowledge and information?

5. What is the full name of the student you wish to enroll in Bedford County Public Schools?

Student Name

6. What are the age, date, and place of birth of the student being enrolled?

Age Date of Birth Place of Birth

7. Who are the parents, parents by legal adoption, or person service in loco parentis and responsible for the

care of the student desired to be enrolled?

Where do you reside?

8. Do you have legal custody imposed by a court order or have you been designated court-appointed

guardian for the student desired to be enrolled?

9. Why are you unable to present a certified copy of the birth record of the enrolling student?

10. What written proof can be or is offered of the student’s identity and age? (Attach same hereto.)

11. To the best of your knowledge has the student ever been reported to any law enforcement agency as a

missing child?

If yes, identify by name and address the law enforcement agency and date of report.

Agency Date of report

Address

Subscribed and sworn to before me this day of , 20

Witness my hand in official seal.

My commission expires: SEAL

NOTARY PUBLIC

Dear Parent/Guardian/Eligible Student:

Bedford County Public Schools considers Guidance and Counseling services essential components of our school program available to all students in Kindergarten through Grade 12. These programs support and enhance the schools’ instructional goals by providing students developmentally appropriate activities, guidance, and counseling in areas of academics, career preparation, and personal/social concerns.

Bedford County Public Schools provides a listing of the names, addresses, and phone numbers of 11th and 12th grade students to Military Recruiters and Institutions of Higher Education.

Please contact your child’s school counselor if you have any questions.

If you DO NOT wish for your child to participate in personal/social counseling activities or for their directory information to be provided please complete the opt-out statement below and return to the Guidance Department before September 28, 2012.

OPT–OUT FORM

I DO NOT want the student listed below to be included in the following:

(CHECK ALL THAT APPLY:

( PERSONAL/SOCIAL COUNSELING

( RELEASE OF DIRECTORY INFORMATION TO MILITARY RECRUITER

( RELEASE OF DIRECTORY INFORMATION TO INSTITUTIONS OF HIGHER EDUCATION

I understand that once this form has been signed by either the parent/guardian or eligible student it is effective for the 2012-2013 school year. If I want to change my decision, the principal must be notified in writing that the form is no longer in effect and that the student can be included in services or directory information can be released.

PRINTED LEGAL NAME OF STUDENT GRADE LEVEL

PRINTED LEGAL NAME OF PARENT/GUARDIAN OR ELIGIBLE STUDENT

SIGNATURE OF PARENT/GUARDIAN OR ELIGIBLE STUDENT DATE

Bedford County Public Schools

[Insert School Name Here]

Student Scholastic Record Sign-Out Sheet

|Student Record Name |Date |Printed Name of Recipient |Signature of Recipient |Returned |Returned to Signature |

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By signing this sheet you agree that the student record and any information it contains will be used only for educational purposes concerning the student. All information is confidential and BCPS has a responsibility to protect the rights and privacy of the student and his/her parents. It is not allowed for any individual to remove, add, or alter any part of a student record that is not specific to your job duties. All other modifications must be approved by the Records Officer, who is currently Melissa Sexton at the School Board Office. See contact information below. All records should be checked out and viewed within the school and are not to be taken off the premises. They should also be viewed in a way that ensures the protection of confidentiality so information should be viewed and accessible only to the person who checked out the record unless it is for an IEP meeting or IDEA hearing where other individuals such as a parent/guardian or a parent’s representative have the right to inspect also. All records need to be returned the same day they are checked out to the principal or the records designee. This sheet is subject to internal audit for compliance.

APPENDIX B

Assorted Forms

Family Life Opt-Out Form Page 34

Foster Care Information Enrollment Form Page 35&36

Press down CTRL button and click on the links below to open.

Homeowner Residency Affidavit LTP Reference

Residency Validation Form LTP Reference

Employee – Student Transfer Form

Non-Resident Transfer Form

School Zone Transfer Form

Dear Parent/Guardian:

Bedford County Public Schools implements a Family Life Education Program in all grades that meet the Standards of Learning objectives and regulations approved by the Virginia State Board of Education.

Upon review of the content of the Family Life curriculum, if you feel any of the content being taught is NOT appropriate for your child, complete the form below by August 31, 2012.

Sincerely,

[Insert Principal Name Here]

Principal

FAMILY LIFE EDUCATION PROGRAM

PARTICIPATION OPT–OUT FORM

During the 2012-2013 school year, I find the material covered under the following Standards of Learning objectives NOT to be appropriate for my child.

, , , , , ,

STANDARDS OF LEARNING OBJECTIVE NUMBER OR NUMBERS

PRINTED LEGAL NAME OF STUDENT GRADE LEVEL

I request that an alternative assignment be given to my child while the Standards of Learning objectives listed above are being taught to the class.

PRINTED LEGAL NAME OF PARENT/GUARDIAN OR ELIGIBLE STUDENT

SIGNATURE OF PARENT/GUARDIAN OR ELIGIBLE STUDENT DATE

FOSTER CARE INFORMATION

ENROLLMENT FORM

STUDENT INFORMATION

Student’s Legal Name: Grade Gender

LAST NAME FIRST NAME MIDDLE NAME

Social Security Number: Birth Date: Age:

Addresses should be same for student and foster parent(s)

Mailing Address:

STREET CITY STATE ZIP

Residence Address: Home Phone:

(If different from mailing address) STREET CITY STATE ZIP

Are you Hispanic? Yes No Please choose your race below (you may select more than one):

American Indian or Asian Black or White Native American or

Alaskan Native African American Other Pacific Islander

Are you a Bedford City or Bedford County resident? Bedford City Bedford County

Does child receive special education services or have a 504 plan? Yes No

If yes, explain:

Does child receive English as a Second Language (ESL) services? Yes No Birth place:

Birth country: Student’s Primary Language: Language spoken at home:

FOSTER PARENT INFORMATION

Foster Parent 1 Legal Name: (circle one) Mr. Mrs. Ms.

Employer: Occupation:

EMPLOYER CITY STATE

Work Phone: Cell Phone: Pager:

Email Address: Language spoken other than English:

Foster Parent 2 Legal Name: (circle one) Mr. Mrs. Ms.

Employer: Occupation:

EMPLOYER CITY STATE

Work Phone: Cell Phone: Pager:

Email Address: Language spoken other than English:

FOSTER CARE INFORMATION

ENROLLMENT FORM (CONTINUATION)

PLACEMENT INFORMATION

Placement Agency: Agency Contact: Agency Phone:

Legal Guardian: Guardian Phone:

County or City of Social Services: School Division of Legal Residence:

LEGAL RESIDENCE: WHERE STUDENT WOULD RESIDE IF HE/SHE WERE NOT IN FOSTER CARE

EMERGENCY INFORMATION

Student’s Special Medical Alert: ALLERGIES, ASTHMA, ETC.

Physician: Phone Number:

Address:

-----------------------

REVISED MAY 2012

Bedford County Public Schools

310 South Bridge Street, Bedford, VA 24523

Phone (540) 586-1045

REVISED MAY 2012

Bedford County Public Schools

310 South Bridge Street, Bedford, VA 24523

Phone (540) 586-1045

REVISED AUGUST 2011

REVISED APRIL 2011

Bedford County Public Schools

310 South Bridge Street, Bedford, VA 24523

Phone (540) 586-1045

REVISED APRIL 2011

Bedford County Public Schools

310 South Bridge Street, Bedford, VA 24523

Phone (540) 586-1045

REVISED APRIL 2011

Bedford County Public Schools

310 South Bridge Street, Bedford, VA 24523

Phone (540) 586-1045

REVISED MAY 2011

REVISED AUGUST 2011

REVISED MAY 2011

Mail Completed Form To:

Gus Exstrom

Supervisor of Student Services

Bedford County Public Schools

600 Edmunds Street

Bedford, VA 24523

Phone: (540) 586-3517

Fax: (540) 586-7740

REVISED MAY 2012

Bedford County Public Schools

310 South Bridge Street, Bedford, VA 24523

Phone (540) 586-1045

Bedford County Public Schools

310 South Bridge Street

Phone (540) 586-1045

REVISED MARCH 2012

REVISED MAY 2011

Insert School Name Here

Address, City, VA Zip

Phone (***) ***-****

REVISED MAY2012

Bedford County Public Schools

310 South Bridge Street, Bedford, VA 24523

Phone (540) 586-1045

REVISED MAY 2011

CONTINUATION PAGE 2

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