Weld County School District RE 8 Fort Lupton Public Schools Fort by gjjur4356


									                                    Weld County School District RE 8
                                      Fort Lupton Public Schools
                                        Fort Lupton, CO 80621
                                          Department of Special Services

REQUEST FOR RECORDS: REGULAR EDUCATION AND SPECIAL EDUCATION                               ______________

I have recently moved my child/children into Weld County School District RE 8 and would appreciate your sending all
pertinent records that would be of use in their continued education.

This information is to be used in planning the child’s educational program. I, as Parent/Guardian, reserve the right to
withdraw this authorization at any time by giving written notice.

   Child’s Name                  Birth date                      Present Grade

   Street Address         City                State              Zip

I hereby give my permission for the release of all available information and reports for the named student to Weld
County School District RE 8.

       Signature of Parent/Guardian – Relationship

Previous School :_____________________________

Street Address:_______________________________

City, State, Zip: ______________________________

Specific information authorized to release:

 X . Regular Education Records             X . Special Education Records
      Health/Immunization Records                Social/Medical Records (Vision & Audiological)
      Transcripts, etc.                          Educational Records
      Other_________________                     Speech/Language Records
                                                 Psychological Records
                                                 Other ___________________

Please send REGULAR EDUCATION and SPECIAL EDUCATION Records to with a copy of this form to:
               Twombly Elementary
               Attention Office/Records
               1600 Ninth Street
               Fort Lupton, CO 80621
               Telephone: (303) 857-7400
               Fax: (303) 857-7497

Revised 5/31/02
                                       Household Information Form

Dear Parent/Guardian,

Weld County School District Re-8 uses Infinite Campus for our student information database. In an effort to
maintain the highest level of data accuracy, integrity and security, we ask that you complete this Household
Information Form if you have made any changes to your family’s information. You may return or fax this
completed form to your child’s school – please do not email it since email is not a secure method of transmission.

We encourage parents to set up their own Parent Portal Account in Infinite Campus in order to see their student’s
class schedule, attendance, grades, and assessments. The Parent Portal can be accessed from home or work by
visiting the for Parents section of the Weld 8 district website at http://www.ftlupton.k12.co.us. To obtain your
access code, you must go to your child’s school (only one if you have more children in other schools) and sign an
access permission form.

                                                Please Print Clearly
Household Information

Last Name: ___________________________________________________________________________________
Physical Address: ______________________________________________________________________________
Mailing Address: ______________________________________________________________________________
City, State & Zip: ______________________________________________________________________________
Main Household Phone Number: __________________________________________________________________

Parent/Guardian Information (1)                                Parent/Guardian Information (2)
Name: _____________________________________                    Name: ____________________________________

Relationship: ________________________________                 Relationship: _______________________________

Home Address: ______________________________                   Home Address: _____________________________

City, State, Zip: ______________________________               City, State, Zip: _____________________________

Home Phone: ________________________________                   Home Phone: _______________________________

Work Phone: ________________________________                   Work Phone: _______________________________

Cell Phone: __________________________________                 Cell Phone: ________________________________

Email: ______________________________________                  Email: ____________________________________

Employer: ___________________________________                  Employer: _________________________________

Legal Guardian: ____Yes ____No                                 Legal Guardian: ____Yes ____No

Resides with: ____Yes ____No                                   Resides with: ____Yes ____No

Court Order: ____Yes ____No                                    Court Order: ____Yes ____No

If YES, copy of court order must be provided.           If YES, copy of court order must be provided

Has your child lived in Colorado continuously since 3/10/06? ____Yes ____No
Has your child lived in the United States continuously since 3/10/06? ____Yes ____No
Is student living in District? ____Yes ____No

Has the student ever attended Fort Lupton Schools? ____Yes ____No          If yes, when? ______________

Previous School Attended: ______________________________               Address: ______________________________
                                       Household Information Form

Student Information
         Legal Name                  Grade            SSN              Birthdate        Gender       (see below-2
     (First, Middle, Last)          (2 Digit)    (xxx-xx-xxxx)      (MM/DD/YYYY)         (M/F)          Digit)

Race/Ethnicity Codes as identified by the Colorado Department of education:

01 – American Indian or Alaskan Native      02 – Asian or Pacific Islander         03 – Black, not Hispanic
04 – Hispanic                               05 – White

Does your child currently have an IEP or Section 504 Plan? ____Yes ____No

Emergency & Health Information
      In case of serious accident or illness at school, your child will be sent to an emergency medical facility.
                              The parent(s)/guardian(s) is responsible for all expenses.

Family Physician’s Name: _______________________________________                   Phone: ____________________

Health/Medial Conditions: _____________________________________________________________________

Does your child take any medications? If so, what? _________________________________________________

Additional Comments: ________________________________________________________________________


Emergency Contact Information (People NOT listed above)
The individuals below have authorization to pick up my child and can be reached during school hours at the number

Name: _______________________________              Relationship: ______________         Phone: __________________

Name: _______________________________              Relationship: ______________         Phone: __________________

Print Parent/Guardian Name: _____________________________________________________________

Parent/Guardian Signature: ____________________________________ Date: ___________________

      Please attach an additional sheet if you need to provide more information for any section.

FLHS Students Only:
Has at least one parent graduated from a 4-year college? ____Yes ____No
We, the parents/guardians of _____________________, request that Fort Lupton HS not release directory
information to the military concerning our son/daughter.

___________________________________________                        _____/_____/_____
Parent Signature                                                   Date
                                   Fort Lupton School District RE-8

                             HOME LANGUAGE CHECKLIST
Date:          /         /
Student’s Name:                                                               Grade:
                                         PLEASE PRINT LEGIBLY
Parent’s / Guardian’s Name:
                                         PLEASE PRINT LEGIBLY
Address:                                                             Phone: (        )

Please respond to ALL of the following questions.
1.     What language did your child learn to speak first?

2.      How often is a language other than English USED in your home? (Check only one.)
        a. Only the other language and NO English.
        b. Other language more often than English.
        c. Other language and English equally.
        d. English more often than the other language.
        e. Only English.

3.      Please describe the language SPOKEN by your child. (Check only one.)
        a. Speaks only the other language and NO English.
        b. Speaks mostly the other language and some English.
        c. Speaks the other language and English equally.
        d. Speaks mostly English and some of the other language.
        e. Speaks only English.

4.      Please describe the language UNDERSTOOD by your child. (Check only one.)
        a. Understands only the other language and NO English.
        b. Understands mostly the other language and some English.
        c. Understands the other language and English equally.
        d. Understands mostly English and some of the other language.
        e. Understands only English.

5.      If your child speaks and/or understands a language other than English, what is the

6.      If this student knows a language in addition to English, did he/she learn it in school?
        Yes                 No

7.      In what language would you like to receive notices from the school?

                        Signature of Parent/Guardian

                                         Thank you very much!

                                                                                                          File: EHC*-E
                            Parent/Student Technology Agreement Form
                                      Internet Use Agreement

The Weld County School District Re-8 (Weld Re-8) technology program provides the tools and strategies for solving
problems, using information, increasing productivity, and enhancing personal growth. Additionally, the District uses
technology to:
    •   deliver Governing Board adopted curriculum and instruction,
    •   improve students' motivation,
    •   provide supervised access to educational Internet websites, and
    •   provide supervised access to email as part of the curriculum.

The District requires that parental permission be given before students can use computers and Internet. Therefore,
the statements below ask your permission to grant your student access to technology equipment.

I _____ grant _____ deny permission for my child to have access to computers and the Internet for educational
purposes only. I understand that Weld Re-8 has taken reasonable precautions to restrict access to inappropriate
materials. However, I also realize that it is impossible for the District to restrict access to all inappropriate materials;
therefore, students are directed to immediately report to school personnel any information that is inappropriate or
makes them feel uncomfortable.

Code of Conduct
    •    Networks within Weld Re-8 have been established for educational purposes. Weld Re-8 reserves the right to
         place reasonable restrictions on the material users access or post through the system.
    •    Students by-passing the internet security system is prohibited.
    •    All web pages created by students and student organizations on the district’s computer system will be
         subject to treatment as district-sponsored publications. Accordingly, the district reserves the right to
         exercise editorial control over such publications.
    •    Sending or displaying offensive messages or pictures on the network/internet will be prohibited.
    •    Gambling on the network/internet will be prohibited.
    •    Illegal solicitations on the network/internet will be prohibited.
    •    Users shall save data files as directed by their teacher or system administrator. Users shall not load any
         software onto a Weld Re-8 computer or on a Weld Re-8 file server unless approved by their teacher or
         system administrator.
    •    Users shall not represent another's work as their own. They shall respect the rights of copyright owners and
         request permission when necessary or otherwise appropriate.
    •    Appropriate language for an education setting shall be used. Users shall not make use of the District's
         computing or network facilities to swear, curse, threaten, or harass. Similarly, the use of vulgar, rude,
         obscene, or disrespectful language is not appropriate.
    •    Users shall notify a teacher or system administrator promptly of any message received that makes them feel
    •    Business activities, Chat Rooms, internet games not approved by the teacher, streaming music and other
         activities as deemed inappropriate are prohibited.
    •    Messages relating to or in support of illegal activities may be reported to the authorities.
    •    District email accounts are not given to students.
    •    Users shall not utilize the District's computing or network facilities to engage in any illegal acts including, but
         not limited to, arranging for the sale of drugs, purchasing alcohol, or engaging in criminal gang activity.
    •    Users agree to not utilize Weld Re-8 computer services, networks, or equipment in any way that may be
         construed as personal in nature or which may result in monetary gain.

We, the undersigned, have read and agree to uphold the Weld Re-8 Code of Conduct:

Student: _____________________________________ Date: __________________

Parent/Guardian: ______________________________ Date: __________________

The computers and network facilities are the property of the District. The District reserves the right to inspect all
computer files and any information transmitted via its computers and network facilities. Inspection may be conducted
by school authorities without notice, consent, or search warrant. Accordingly, no user should have any expectations
of privacy in any information that is transmitted, received, or stored on District computers or network facilities. This
specifically applies to, but is not limited to, e-mail and internet messages and information.

                     Approved: September 8, 1997 Revised: September 13, 1999 Revised: April 14, 2008
               Release Form for Electronically Display of Student Picture and/or Work

                                                   2009 – 2010
Dear Parent(s)/Guardian(s),
The Weld Re-8 School District hosts a site on the World Wide Web at www.ftlupton.k12.co.us. The World Wide
Web is a part of the Internet connecting thousands of computers and millions of individual subscribers all over the
world. On the Weld Re-8 School District web site as well as on each school site within the district, staff members
post a wide variety of information regarding the district. Anyone in the world with web access is welcome to visit
our site and download this information at any time. The potential audience is in the hundreds of millions.

Individual teachers also publish their own web pages on their school’s web site, and frequently these teachers wish
to publish photographs of their students and/or samples of their students’ work.

This form is for parent(s) or guardian(s) to express their wishes regarding the electronic display of their student’s
work or photograph on the Internet. Please check only one box indicating your wishes, sign the form, and return the
form to the appropriate schools. Names will not be published. Thank you.

Please check only one of the levels below:

    Both my child’s work and photograph may be electronically published on the district’s web site (student’s
    name will not be published).

    Only my child’s work may be electronically published on the district’s web site. His/her photograph may
    not be published (student’s name will not be published).

    Neither my child’s work nor his/her photograph may be electronically published on the district’s web site.

   _______________________________________                  _______________________________________
         Student’s Name (please print)                          Parent/guardian’s Name (please print)

   _______________________________________                              _____/_____/_____
         Parent/guardian’s Signature                                          Date
                         WELD COUNTY SCHOOL DISTRICT RE-8
                                                  Fort Lupton Public Schools
                                                     301 Reynolds Street
                                                   Fort Lupton, CO 80621
Fax: 303-857-3219                                                                                      303-857-3200

Please answer the following questions and return this form to school as soon as possible. Your
information is confidential. Thank you.

     1. Have you lived at your present address for less than 3 years?                YES      NO

     2. Has either parent/guardian ever intended to work in, looked for employment, or worked in any
        of the following areas in the past 3 years?

     If yes, please mark the appropriate employment areas with an X.

        θ Farming/Ranching                                   θ Trucking/Hauling Fruits or Vegetables
        θ Planting/Harvesting Field Crops                    θ Canning
        θ Poultry                                            θ Orchards
        θ Dairy                                              θ Greenhouse/Nursery
        θ Food Processing Plant                              θ Christmas Tree Processing/Forestry
        θ Meat Packing Plant                                 θ Irrigation
        θ Sort/Grade/Sack Vegetables and/or Fruits           θ Fence Construction
        θ Clean/Prepare/Pack Vegetables and/or Fruits θ Sod Farms
        θ Seed Packaging                                     θ None of the above
        θ Feed Lots

3.      Parents/Guardians Names:                                                      Date: ___________

        Address:                                                               ___    Apt #____________

        City:                                                         ____ Zip Code:                   _____

        Phone number (         )                              ___      Best time to call:              _____

4.      Please list all children in your home from birth to 21 years of age.
                    First and last Name                   Date of Birth                     School


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