Student Services Handbook - Palm Springs Unified School

Transcription

STUDENT SERVICES
2013/2014 Handbook
STUDENT SERVICES
ORGANIZATIONAL CHART . . . . . Page 2
ATTENDANCE
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CWA Referral for Home Visits . . . . . . Page 3
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School Attendance Review Board
(SARB) . . . . . . . . . . . . . . . . . . . . . . . . . . Page 5
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Truancy (Compulsory Education) . . . . Page 6
ALTERNATIVE EDUCATION
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Alternative Education . . . . . . . . . . . . . . Page 7
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Home Hospital . . . . . . . . . . . . . . . . . . . . Page 9
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Homeless Shelter Information . . . . . . . Page 11
ENROLLMENT
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Caregiver Affidavits . . . . . . . . . . . . . . .Page 14
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Enrollment of Pupils . . . . . . . . . . . . . . .Page 17
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Immunization Requirements . . . . . . . .Page 18
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Enrolling Students from Placement . . Page 23
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Intra/Inter District Transfers . . . . . . . Page 24
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Lunch Applications (free/reduced) . . . Page 29
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Residency Affidavit . . . . . . . . . . . . . . . .Page 30
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Release of Information . . . . . . . . . . . . . Page 37
INTERVENTIONS
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Counseling Services . . . . . . . . . . . . . . . Page 58
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INSIGHT Programs (Counseling) . . . Page 59
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Section 504 . . . . . . . . . . . . . . . . . . . . . . .Page 60
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Student Assistance Programs . . . . . . . .Page 61
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Student Success Team . . . . . . . . . . . . . Page 62
PUPIL RECORDS
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Cumulative Records . . . . . . . . . . . . . . .Page 63
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Subpoenas . . . . . . . . . . . . . . . . . . . . . . .Page 68
SAFE SCHOOLS
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Child Abuse Reporting . . . . . . . . . . . . Page 69
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Custody Issues . . . . . . . . . . . . . . . . . . . Page 74
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Dangerous Student Notification . . . . .Page 75
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Emergency Management Plan . . . . . . Page 77
DISCIPLINE
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Expulsion Process . . . . . . . . . . . . . . . . . Page 40
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Law Enforcement-Access to Students . Page 53
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Notification of Law Enforcement . . . . .Page 54
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Suspension Notification . . . . . . . . . . . . Page 55
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Teacher Notification of Suspended
Students . . . . . . . . . . . . . . . . . . . . . . . . Page 57
Forms available on
Student Services Web-Site
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Michael C. W. Wong
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Andrew Alaniz
Sonya Rangel
(TBA)
(TBA)
PREVENTION
SPECIALIST
Deanna Bretado-Chavez
Eva De Leon
Jazmin Rodriguez
Lilian Torres
Lorena Castaneda
Roberta Giron-Viazcan
Rosalba Aguilera-Longoria
Susana Cabeje
District Community Liaisons
OFFICE SPECIALIST-BILINGUAL
(760) 416-6027
Mario Castro
OFFICE SPECIALIST-BILINGUAL
(760) 416-6026
Salomon Cavazos
COORDINATOR OF STUDENT
ASSISTANCE PROGRAMS
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Health Service Plans
Home and Hospital Program Screening
Home Visits
Liaison-Community Agencies/ Medical Care Facilities
Liaison-Local Health Department
Mandated Vision/Hearing / Scoliosis Screening
Pre-School Health Screening
Puberty Education
Special Education Health Issues
State Mandated Reports
HEALTH SERVICES
504 Plans
Alternative Education Screening Panel
Cal Works Legislation Implementation
California Healthy Kids Survey
Child Abuse Reporting
Child Custody / Caregiver Affidavit / Shared
Residency
Community School Liaison Team
County CWA Meetings
Court Placement Re-entry
Crisis Intervention
District Attorney Mediation
District Discipline Committee
District Student Assistance Program
Essential Student Support
Expulsion Process
Expulsions and Suspension Data
Homeless Services/Foster Youth
Inter-Agency Contracts/Counseling Services
Intra/Inter District Transfers
Medi-Cal Oversight Committee
Monitor, Supervise Court Minute Orders and
Subpoenas
Student Attendance Review Board (SARB)
Student Services Related Training
Supervise Community Liaisons/Home Visits
Drop-Out Intervention
Truancy Notifications
STUDENT SERVICES
DIRECTOR OF
STUDENT SERVICES
Jane E. Mills
Sylvia Lerias
Bridget Lucardie – Nurse
Christine MacCalla – Nurse
Kathleen Chambers – Nurse
Karin Sabala -– Nurse
Karin Straumietis – Nurse
Kim Jordon – Nurse
Patty Boffa – Nurse
07/01/13
ACCOUNTING TECHNICIAN
 MAA/ LEA Medi-Cal Billing
(760) 416-6196
Carol Keyes
ADMINISTRATIVE SECRETARY
(760) 416-8087
Jacqueline Sifuentes
 Gerardine Dooley – LVN
 Bridget Vasquez – LVN
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LEAD NURSE
Gennette Furtado
ADMINISTRATIVE SECRETARY
(760) 416-6032
Ana Palomar
SENIOR ADMINISTRATIVE ASSISTANT
(760) 416-6029
ATTENDANCE
CWA-Referrals for Home Visits
A Child Welfare and Attendance (CWA) referral form can be accessed by going to Palm
Springs Unified School District Website under “Student Services.”
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Requesting School must complete the CWA referral form and email (as an attachment) to
[email protected] for processing.
Community Liaison will be assigned to do a home visit.
Community Liaison will send the requesting school a disposition and will file a copy at
our [email protected] website for storage.
School site may request a copy should they misplace or lose their referral.
*Please allow some response time for request to be processed.
Note: When a “CWA” home visit request is submitted, the requesting school site should
record this in the Student Information System for documentation.
For more information, please contact:
Jane Mills, Director
Student Services
Office: (760) 416-6030
Fax: (760) 416-6038
Forms available at
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REFERRAL FORM
TO
CHILD WELFARE AND ATTENDANCE
Date:
Referring Person:
School:
Position:
Student’s Name:
F
Parent’s Name:
Siblings:
M
Grade Level
School(s):
Address:
Street
Parent’s Telephone:
City, CA Zip Code
Home
Social Concerns:
Violence
Drugs
Runaway
Contacts made by:
Phone
Mail
Conference
Home Visit
Work
Academic/Behavior:
Health Concerns:
In-school Intervention
Shortened Day
PM/PM
Short Term IS
GED Prep
Special Education
Detention
Saturday School
Other
Head Lice
On Medication
Language spoken at
home:
Spanish
English
Other
Opportunity Program
Contracts
Emergency/Other
Service rendered by
school:
Nurse
Psychologist
Counselor
District Security
(Assistance Requested)
For this visit
In the past on this
family
Other (Please specify)
Comment(s):
THE FOLLOWING MUST BE ATTACHED:
COPY OF EMERGENCY CARD
ATTENDANCE PRINTOUT
Disposition:
Email referral to: [email protected]
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STUDENT PROFILE(STU)
ATTENDANCE
School Attendance Review Board (SARB)
Monitoring and supporting the attendance of students in the district.
Description of steps:
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SART (School Attendance Review Team): SART Contract or other attendance
strategies achieved at the site level. All interventions are to be documented in “Student
Information System.”
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Group DA Mediation: Held as a large group information meeting with parents, twice a
year in the Fall and Spring semesters.
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Formal SARB: Meeting with individual families by one of three district SARB panels.
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DA Mediation: Individual Family DA Mediation meeting.
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Filing by DA: For prosecution in Juvenile Court.
Michael C. W. Wong, Coordinator
Student Assistance Programs
Office: (760) 416-6026
Fax: (760) 416-6038
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ATTENDANCE
Truancy (Compulsory Education)
Education Code Section 48260
District is obligated, under statutory law to notify the parent/guardian when any combination
of the following occur:
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Pupil absent from school without valid excuse on three (3) full days in one school year
Tardy more than 30 minutes during school day without valid excuse on three (3) days in
one school year.
Notification to parent that their student is ‘truant’ must include the following elements:
Compulsory law, penalties right to conference, appeals process.
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Parent is obligated to compel the student to attend school
Parent may be guilty of infraction of the law if fails to meet obligation
Parent can be offered alternative educational programs (if available)
Parent has right to meet with appropriate school personnel to discuss solution
Truancy can result in a referral to SARB
Prior to any referrals, school shall consider all available school and district resources, program
adjustments, alternative education, community agency services to achieve regular student
attendance.
Student Services
Office: (760) 416-6026
Fax: (760) 416-6038
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Alternative Education
Alternative Education can be a school program or class within a school, which
is designed for students to obtain an education by using their special interest,
abilities and/or needs.
An array of educational options have been established within the Palm Springs
Unified School District to serve those students whose potential can best be
developed outside the regular program.
MT SAN JACINTO CONTINUATION HIGH SCHOOL
Dr. Milt Jones, Principal
Counselors: Jaime Soria (A-L)
Cherry Remboldt (M-Z)
Phone: 770-8563 / Fax: 770-8568
Continuation grades 10-12 (age 16 and older)
RAMON
ALTERNATIVE CENTER
DESERT HOT SPRINGS
ALTERNATIVE CENTER
Joddi De Marco, Assistant Principal
Brad Bryeans, Vice Principal
Counselor: Randelle Kirkemo
Phone: 329-3330
Fax: 329-6677
Counselor – Brenda Gunderson
Phone: 778-0487
Fax: 778-0497
Students must meet all district standards and take
all mandated district tests and exams.
**For inquiries on “Advanced Academics Independent Study” (on-line)
please contact Joddi DeMarco at DHS Alternative Center (760) 329-3330**
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PALM SPRINGS UNIFIED SCHOOL DISTRICT
ALTERNATIVE EDUCATION REFERRAL FORM
Student name:
Last
First
M.I.
City
Zip
Parent/guardian:
Address:
Street
Phone Number: Home:
Wk:
Referring school:
Program requested:
Zangle ID #
DOB:
Cell:
Current Grade:
Grad Yr:
 Former Sp. Ed Std. _________  IEP due _______________
 504 due _____________
_________________________
 Psych’s Review (If exited at last year) _________________________
 Interventions _____________________________________________________________________
 SST _____________________  Tutoring ______________
 Probation ___________
 Counseling _______________
 YAT _________________
 Academic needs __________________________________________________________________
 Social/Emotional/Behavioral needs ___________________________________________________
 Health needs _____________________________________________________________________
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Please attach the following
Test History
Attendance Summary (not daily report, only summary)
Behavior Report
Transcript
_____________________________
Student signature
______________________________
Parent signature
____________________________________________________________
Counselor’s Signature
_________________
Date
_________________
Date
For Office Use Only
Additional information: _______________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________
______________________________
_____________
Site Approval
Program
Site
__________________________________________
District Approval
______________________________________
Program
_________________
Site
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____________
Date
_______________
Date
Home and Hospital Program Screening
Home and Hospital Program Screening for Grades K-12
Instructional delivery model:
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This is an independent study program designed for students who are ill and are unable to
attend school as determined by a doctor. A course of study is provided by the home school
and teachers work with the student at their home for five hours a week.
Students who would benefit:
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Students who need to be enrolled for compulsory education but are unable to attend school.
If regular education student, please contact School Nurse.
If special education student, please contact the School Nurse or Kathy Little, Director Special
Education Department (760) 416-6034.
Health Services
Office: (760) 416-8087
Fax: (760) 416-6038
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FLOW CHART
Parent Wants to Access
Home and Hospital
GENERAL EDUCATION
SPECIAL EDUCATION STUDENTS
Special Ed Students/Special Ed Medical Needs only.
Refer to Director of Special Ed or Special Ed
Coordinator
General Ed Students refer to
School Nurse
Nurse Consult’s w/parent to
assure appropriate placement
& explore alternative
education.
Special Ed Medical only, Director/Coordinator
consults with school nurse
Special Ed Director/ Coordinator review
completed form, sign and attach IEP addendum
School Nurse reviews, signs and
gives form to Health Services
Secretary
Director/Coordinator gives form to Health
Services Secretary. HS secretary gives
completed form to Lead Nurse for signatures
Lead Nurse signs after final review of application for medical only student (Regular Ed or Spec. Ed) and
forwards Placement Form to Health Services Secretary
Health Services Secretary forwards Placement Form to Director of
Student Services for signature.
Placement Form is returned to Health Services Secretary. HS secretary e-mails
Ramon Alternative Center Secretary, Vice Principal, Counselors, Registrars, and
School Nurse final approved placement form. RAC Secretary or Vice Principal
Assign Teacher.
Counselors and/or Registrars forward Independent Studies Master Agreement
to Ramon Alternative Center
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Homeless Shelter Information
Student/s who lack a fixed, regular and adequate nighttime residence is identified as
“homeless.” (living in streets, car/s, abandoned buildings or other inadequate
accommodations, etc.)
Shelter Program Access:
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Students who are enrolled in K-12 grade in the district and are by the above definition
homeless may access the program through the following shelters:
If student is or becomes homeless and are in need of assistance, please contact our
Student Services department (760) 416-6030.
HOMELESS RESOURCES:
Roy’s Desert Resource Center (www.vcrivco.org)
19531 McLane Street
Palm Springs, CA 92262
Main Office: (760) 760-676-5200
Martha’s Village & Kitchen ([email protected])
83791 Date Avenue
Indio, CA 92201
Main Office: 760) 347-4741
Housing & Urban Development (HUD) (www.hud.gov/homeless)
Dial 2-1-1 is an easy to remember telephone number that connects people with important
community services.
Student Services
Office: (760) 416-6030
Fax: (760) 416-6038
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Roy’s Desert Resource Center
(RDRC)
The information contained in this referral will be used to determine and verify the eligibility of individuals and
families for services provided by RDRC.
Client name (Last, First Middle) Please note that all adults must complete a separate referral form.
Gender:
Male
Female
Date of birth:
_____/_____/_____
Social Security number of the referred
adult
Phone number:
U.S. citizen:
Yes
No
Does the adult client or child
receive mental health
services?
Yes
No
Does the adult client or child
have a physical disability?
Yes
No
_______/_______/_______
Number of individuals being referred:
Age:
__________
Alternate phone number:
Adults:___________
Children:___________
Does client(s) have birth certificate or other types of identification?
Family status of applicant:
Single adult
Single parent with dependent children
Yes
No
Two-parent family with dependent children
Ages of the children:
In what city was the client’s last permanent address?
In which city did the client sleep in last night?
Does the client(s) receive any of the following:
SSI $________ SSDI
$________ Employment
$________
Welfare
$__________ Unemployment
$_________ Child support
Food stamps
Other _______________________ $______________
$__________
$____________
Please check one of the following statements that applies to the individual’s or family’s current homeless status:
The client or family is currently sleeping in places not meant for human habitation, such as cars, parks, sidewalks,
abandoned buildings (on the street).
The client or family is currently staying in an emergency shelter.
The client or family is currently enrolled in transitional or supportive housing for homeless persons who originally came
from the streets or emergency shelter.
The client or family slept or stayed in any of the above places but is spending a short time (up to 30 consecutive days) in a
hospital or other institution.
The client or family is being evicted within seven days from a private dwelling unit and no subsequent residence has been
identified, and lacks the resources and support networks needed to obtain housing.
The client is being discharged within a week from an institution, such as a mental health or substance abuse treatment
facility or a jail/prison, in which they have been a resident for more than 30 consecutive days and no subsequent residence
has been identified, and lacks the resources and support networks needed to obtain housing.
The client or family is fleeing a domestic violence housing situation and no subsequent residence has been identified, and
lacks the resources and support networks needed to obtain housing.
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THIS SECTION IS MANDATORY
and MUST be completed by the referring agency
Please call 760-676-5200 for space availability
and/or
Fax to 760-676-5201
Please describe why the client is homeless.
For example
The client is sleeping in a car or on the street
Or
The client is being evicted in five days.
THIS SECTION MUST BE COMPLETED
__________________________________________________________________________________________________________
REFERRING AGENCY INFORMATION
Agency name:
Address:
City:
State and zip code:
Contact person (print)
Phone:
Fax number:
Signature:
Date:
For staff use only
Date received:
Staff signature:
_____/_____/_____
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ENROLLMENT
Caregiver Affidavits
Students who do not live with parent/s or legal guardian/s but live with an adult 18 or over
who resides within district boundaries, must complete a “Caregiver Affidavit” (Relatives,
parents of friends, boyfriend or girlfriend, etc).
The Caregiver Affidavit:
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Does not create legal guardianship, only ‘statement of fact’ that minor student is
living within district boundaries.
The “Caregiver” is required to sign affidavit under penalty of perjury.
A New form is required each school year.
Affidavit protects district from litigation by parents and gives it authority to enroll and
educate minor.
Use of Caregiver Affidavit establishes residency in Palm Springs Unified.
Refer to Student Services if grade level is impacted and school site placement is
needed.
IMPORTANT: Caregiver Affidavit is not to be used for guardian signatures on “Special
Education” documents. A Caregiver Affidavit does not establish “Educational Rights.”
Student Services
Office: (760) 416-6030
Fax: (760) 416-6038
Forms available at
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Caregiver’s Authorization Affidavit
THIS DOCUMENT IS FOR THE PURPOSES OF ENROLLING IN PALM SPRINGS UNIFIED.
IT DOES NOT GUARANTEE ENROLLMENT AT A SPECIFIC SCHOOL SITE.
Completion of student name, date of birth, caregiver’s name/DOB/School Name, Grade/ new home address, and the signing of
the affidavit are sufficient to authorize the enrollment of a minor in school and approved school-related medical care.
CAREGIVER AFFIDAVIT IS NOT TO BE USED FOR GUARDIAN SIGNATURES ON SPECIAL EDUCATION DOCUMENTS.
Student Name
(Last)
Student’s Date of Birth
SCHOOL
GRADE
(First)
Caregiver’s Name
(Last)
Caregiver Phone (Day)
(First)
Caregiver Address
City
Zip
Caregiver Driver’s License or ID Card Number
(
)
Caregiver Phone (Evening)
Check:
(
)
Caregiver Date of Birth
Check:
Home
Home
Work
Work
Verification of the following two areas are required to authorize any other medical care.
Caregiver Authorization for Other Medical Care
I verify that I am of legal adult age and this minor student lives in my home.
I also verify that:
1.
I am the: (Check the one which identifies you)
Grandfather or
Grandmother
Aunt
or
Uncle
Sister
or
Brother
Step-Mother or
Step-Father
Step-Sister or
Step-Brother
Cousin
or
Non-relative (relationship): __________________________
2.
The following is/are the name(s)/location(s) of parent(s)/guardian(s) having legal custody:
a. Father/legal guardian
b. Mother/legal guardian
(Name/Location)
(Print Name)
(City/State/Country or unknown)
(Print Name)
(City/State/Country or unknown)
(Name/Location)
Check one or more: (For example, if one parent was advised and the other could not be located)
_ _ I have advised the parent(s) or other person(s) having legal custody of the minor as to
my intent to authorize medical care and have received no objection.
_
_
I am unable to contact the parent(s) or legal guardian(s) at this time to notify them of
my intended authorization.
WARNING: I declare under penalty of perjury under the laws of California that the foregoing information is
true and correct.
Signature of Caregiver: ________________________________________________________ Date: __________________
Received by:
Date:
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DISTRITO ESCOLAR UNIFICADO DE PALM SPRINGS
Declaración de Autorización del Cuidador
ESTE DOCUMENTO ES PARA EL PROPOSITO DE INSCRIPCION
DENTRO DEL DISTRITO ESCOLAR UNIFICADO DE PALM SPRINGS.
ESTE NO GARANTIZA LA INSCRIPCIÓN EN UNA ESCUELA ESPECIFICA.
Al completar el nombre del estudiante, fecha de nacimiento, nombre del cuidador /FDN/Nombre de Escuela, Grado, nueva
dirección, y la firma de la declaración son suficientes para autorizar la inscripción del menor en la escuela y aprobar cuidado
médico relacionado con la escuela.
ESTA DECLARACION NO PUEDE SER USADA COMO FIRMAS DEL TUTOR PARA FIRMAR EN DOCUMENTOS DE EDUCACION ESPECIAL
Fecha de Nacimiento del
estudiante
Nombre del estudiante
(Apellido)
Escuela
Grado
(Nombre)
Teléfono (Día) del Cuidador
Nombre del Cuidador
(Apellido)
(Nombre)
Dirección del Cuidador
Ciudad
Código
Núm. De Licencia o Tarjeta de Ident. del
Cuidador
(
)
Marque:
Teléfono (noche) del Cuidador
Casa
Trabajo
(
Casa
Trabajo
)
Marque:
Fecha de nacimiento del Cuidador
Verificación de las dos siguientes áreas son requeridas para autorizar cualquier cuidado médico.
Autorización del Cuidador para otro cuidado médico
Yo verifico que soy un adulto de edad legal y que este estudiante menor de edad vive en mi casa.
También verifico que:
1.
Soy el/la: (Maque la que lo/a identifique)
Abuelo
o
Abuela
Tía
o
Tío
Hermana
o
Hermano
Madrastra
o
Padrastro
Hermanastra o
Hermanastro
Primo
o
Ningún-relación (clasificar relación): _____________________
2.
Lo/s siguiente/s es/son el/los nombre(s)/lugar(es) de los padre(s)/tutores que tienen custodia
legal
a. Padre/tutor legal
(Nombre/ubicación)
(Nombre -letra de molde) (Ciudad/Estado/País o desconocido)
b. Madre/Tutor legal (Nombre/ubicación)
(Nombre -letra de molde) (Ciudad/Estado/País o desconocido)
Marque uno o más: (Por ejemplo, Sí uno de los padres
_
fue informado y el otro padre no pudo ser localizado)
_
He informado a/los padre(s) u otra persona quién tiene custodia legal del menor de mi
intención de autorizar cuidado médico y no he recibido ninguna objeción.
_ _ No he podido comunicarme con el/los padre(s) o tutor legal en este momento para
avisarles de mi intención de autorizar.
AVISO: Declaro que esta información es fiel y verdadera bajo pena de perjuicio según lo dispone las leyes
de California.
Firma del Cuidador: ________________________________________________________ Fecha: __________________
Recibido por:
Fecha:
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ENROLLMENT
Enrollment of Pupils
Critical Questions to ask at the time of enrollment.

Is the student getting Special Education services?

Does the student have a 504 Plan?

Is the student presently on Expulsion status from a school district?
(Contact Student Services office for assistance regarding expelled students)

Kindergarten Admission (See attached guidelines)
Proof of Age can be established by:
Birth certificate
Certified copy of birth record
Baptism certificate
Passport
Immigration certificate
Bible record
Without any of the above, an affidavit by parent or other ‘reasonable’ means to verify age.
Physical Exam Form All children must have received within 18 months prior to entering
1st grade.

Certification of exam or

Waiver signed by parent/guardian
Immunization Records must be current:
T-dap - For the 2012-2013 school year, and all future school years, all students entering, advancing or
transferring into 7th grade will need proof of an adolescent whooping cough booster immunization (called
“Tdap”) for school in the fall.
Exemptions to immunization should not be taken because of convenience. Unimmunized students are at
greater risk of contracting diseases and spreading. Schools should maintain an up-to-date list of students with
exemptions, so that these students can be excluded from school quickly if an outbreak occurs.
Student Services (760) 416-6030
Health Services (760) 416-8087
Fax: (760) 416-6038
Forms available at
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ENROLLMENT
Enrolling Students from Placement
Students who are coming directly from a placement situation must contact the Student
Service office to schedule an appointment for a placement interview.
Examples of placements include, but are not limited to:

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
Long-term placement in a Juvenile Detention Facility
Foster Care
Drug/Alcohol Treatment Center
NOTE: Please do not send parent/guardian or student directly to the District office without
calling. Administrator/s may not be available to assist this parent. Instead, please have
parent call for an appointment.
Student Services
Office: (760) 416-6030
Fax: (760) 416-6038
23
ENROLLMENT
Intra/Inter District Transfers
Palm Springs Unified School District is an ‘Open Enrollment’ district (as of July 1, 1994).
This means that a parent/guardian can request to transfer their children to a school in the District other than that of his/her regular attendance area. Transfer granted upon space availability
at the school of choice.
Process to apply for an Intra-District Transfer is as follows:









Parents must complete an Intra-District Transfer permit through our PSUSD KIOSK Computer Stations in Student Services office (during regular office hours) except holidays.
Student/s must be enrolled in their school of residence while pending transfer approval. If parent unsure
as to their “school of residence”, they can go to our district website www.psusd.us “Find My School”.
Deadlines for submitting applications are listed in our PSUSD Website.
A Lottery system will be utilized if the number of requests exceeds the spaces available.
Placement in Alternative Education Schools/Programs is completed through Alternative Education
Screening Panel, NOT through the transfer process.
Special Education transfers are determined through the Special Education Department.
District retains authority to revoke transfers should ‘overload’ occur.
If student has excess absences, tardiness, etc., they may be referred to SARB process and transfer may be
revoked.
If transfer approved, parent/guardian agrees to provide transportation to approved school.
Note: If student is currently on an approved Intra-District Transfer, he/she does not have to apply again as
long as student remains in same school.
Process to apply for an Inter-District Transfer is as follows: (Agreement between districts) If
student moves outside Palm Springs Unified School District boundary, student must secure an Inter-District
Transfer.
 District of residence originates agreement
 Parent must complete the Inter-District Transfer form and submit to Student Services
 Failure to adhere to terms/conditions may result in revocation of transfer
 District policy requires annual renewal
 Student cannot be enrolled until agreement has been approved
Student Services
Office: (760) 416-6027
Fax: (760) 416-6038
24
New
Renewal
PLEASE PRINT
Pupil’s Last Name
REQUEST FOR INTERDISTRICT ATTENDANCE PERMIT
(One Application per Child)
School Year:
Pupil’s First Name
Date of Birth
Grade Requested
Parent/Guardian
Home phone
Work/cell phone
Residential Address
City/Zip Code
Mailing Address if different
City/Zip
District of Residence
School of Residence
District of Desired Attendance
School of Desired Attendance
District Now or Last Attended
School Now or Last Attended
Reason for request (see explanation on reverse side):
Explanation of reason(s) for request:
Senior Student
Specialized High School Program
Planned Change of Residence
School District Employment
Child Care
Other
Provide full name, address and phone number of child care provider or school district employer, if you checked
either of those boxes.
Check appropriate special program (if applicable):
Special program/class Program/Class______________________________(RSP, SDC, APE, S/L, OT, GATE)
Section 504 Accommodations
Currently suspended or expelled
TERMS & CONDITIONS: This permit is valid only for the school year granted, while conditions stated are
maintained, and as long as the student’s attendance, citizenship and scholarship are satisfactory to the district of
attendance. A permit may be revoked for cause at any time. False or misleading information may be cause for
denial or revocation. Approval is subject to space availability in the district and may not be at the site requested.
Individual district policies pertain to each permit.
Parent initials______
I have read and understand the regulations and policies governing interdistrict attendance permits (on reverse side)
and hereby submit my application. I declare under penalty of perjury that the information provided above is true
and accurate. I understand that this form will be provided to the district of residence and the district of desired
attendance and information provided is subject to verification.
Signed_________________________________________________Date_____________
For School District Office Use Only
As the authorized administrator for the district of residence, I recommend the following action:
Approval for release pending concurrence with receiving district
Disapproval
Signature____________________________________________ Date_______________
As the authorized administrator of the district of desired attendance, I recommend the following action:
Approval to attend
Disapproval
Signature____________________________________________ Date_______________
Reason for denial:____________________________
25
Riverside County
Regulations and Policies Governing Interdistrict Attendance Permits
1. In accordance with Sections 46600 to 46609 of the Education code, the school districts of Riverside County
establish Interdistrict agreements annually which provide for the exchange of pupils.
2. The enrollment of pupils from districts, other than that of residence is not mandatory. If there is sufficient room
in the district, school, and program of desired attendance, requests will be considered, provided the reasons are
justifiable and in accordance with district governing board policy.
Interdistrict Attendance Permits to leave the district of residence may be granted for the following reasons:
a. Senior Student – The district may permit those pupils who are in the highest grade of elementary,
middle or senior high school permission to graduate from the school which they have attended just
prior to their move to another district.
b. Specialized High School Program – Availability of a specialized high school program in the
district of desired attendance was not available in the district of residence. If the district of
residence has a similar program, the student does not qualify under this category.
c. Planned Change of Residence – Specific and written evidence must be given that a residence in
the district of desired attendance is being obtained. Such permit should not be issued for longer
than three months.
d. School District Employment – Parent/legal guardian employed by the school district of desired
attendance. Verification required.
e. Child Care – These are to be initially granted only to kindergarten through eighth grade school
age students, when it is impossible to arrange adequate childcare or supervision in the district of
residence. Verification must be provided.
3. Requests based upon convenience or personal preference may not be considered.
4. Transportation is the responsibility of the parent/guardian.
5. Procedure for making application for Interdistrict attendance:
a. Complete the Request for Interdistrict Attendance Permit and fill in “reasons for request” in space
provided. Provide any additional support documents as needed. Be sure to sign the application.
b. Submit the request for approval to the authorized district administrator in the district of residence.
c. If approved, take request form to authorized administrator of school district of desired attendance.
d. The parent/guardian will be notified by mail of the final decision regarding the request.
If you have any questions pertaining to the procedure outlined above, the office from which you obtained this
form in the school district of residence will assist you.
6. An Interdistrict Attendance Permit for Interdistrict attendance is valid only during the school year for which it is
issued. It is furthermore valid only while the conditions stated in the request are maintained; and will be continued
in force only as long as the pupil’s attendance, citizenship, and scholarship are satisfactory to the school of
attendance.
7. Falsification of any information stated on this request is cause for immediate revocation of an interdistrict
transfer and no further application will be considered.
8. California Interscholastic Federation grades 9-12 athletic eligibility may be negatively affected by this transfer.
(CIF Southern Section Blue Book section 206)
APPEAL PROCESS: MUST APPEAL TO DISTRICT THAT DENIED THE REQUEST
26
DISTRITO ESCOLAR UNIFIFCADO DE PALM SPRINGS
SOLICITUD PARA PERMISO DE ASISTENCIA INTERDISTRITAL
(Una solicitud por niño)
Nueva
Renovación
Año escolar
USE LETRA DE MOLDE
Apellido del alumno
Nombre del alumno
Fecha de nacimiento
Grado solicitado
Padre o tutor
No. teléfono de casa
No. teléfono de trabajo o celular
Dirección de casa
Ciudad y zona postal
Domicilio de correo si es diferente
Ciudad y zona postal
Distrito de residencia
Escuela de residencia
Distrito adonde desea asistir
Escuela adonde desea asistir
Distrito al que se asiste o asistió
Escuela a la que asiste o asistió
Motivo de la solicitud (ver explicación al dorso):
Alumno por egresar (Senior)
Explicación del motivo de la solicitud:
Programa especializado de preparatoria
Plan para cambiar de residencia
Empleo en el distrito escolar
Cuidado infantil
Otro
Dar el nombre completo, dirección y número de teléfono del proveedor de cuidado infantil o nombre del
distrito escolar con el cual trabaja si marcó alguna de esas casillas.
Marcar el programa especial apropiado (si aplica):
Programa o clase especial
Programa o clase
Ajustes según la Sección 504
Actualmente suspendido o expulsado
(RSP, SDC, APE, S/L, OT, GATE)
TÉRMINOS Y CONDICIONES: Este permiso es válido sólo por el año escolar concedido, mientras que las
condiciones indicadas continúen y mientras que la asistencia, buena conducta y becas se mantengan a
satisfacción del distrito de asistencia. Un permiso puede ser revocado con causa en cualquier momento. La
información falsa o sujeta a mala interpretación pudiera ser causa de la desaprobación o revocación. La
aprobación queda sujeta a la disponibilidad de lugares en el distrito escolar y pudiera no ser en el plantel
solicitado. Las políticas individuales de los distritos aplican a cada permiso.
Iniciales del padre ___
He leído y entendido las regulaciones y políticas que rigen los permisos de asistencia interdistrital (al dorso) y
en este momento presento mi solicitud. Yo declaro bajo pena de perjurio que la información proporcionada
anteriormente es veraz y precisa. Yo entiendo que este formulario será presentado al distrito de residencia y al
distrito adonde se desea asistir y la información proporcionada queda sujeta a la verificación.
Firmado
Fecha
Únicamente para uso de la oficina del distrito escolar
Como administrador autorizado del distrito de residencia, yo recomiendo la siguiente acción:
Aprobación del permiso pendiendo el acuerdo del distrito que lo recibe
No Aprobada
Firmado
Fecha
Como administrador autorizado del distrito al que se desea asistir, yo recomiendo la siguiente acción:
Aprobado para asistir
No Aprobada
Fecha
Firmado
Motivo de el rechazado:
27
Riverside County
Regulaciones y políticas que rigen los permisos de asistencia interdistrital
1.
De acuerdo con las secciones 46600 a 46609 del Código de Educación, los distritos escolares del condado
de Riverside establecen acuerdos Interdistritales anualmente que permiten el intercambio de alumnos.
2.
La inscripción de alumnos en distritos que no sean los distritos de residencia no es obligatoria. Las
solicitudes serán consideradas si hay suficiente espacio en el distrito, escuela o programa al cual se desea
asistir con la condición de que los motivos se justifiquen según las políticas que rigen al distrito.
Los permisos de asistencia Interdistrital para salir del distrito de residencia pueden ser otorgados por
los siguientes motivos:
a. Alumnos por egresar: El distrito puede permitir a aquellos alumnos que cursen el grado
superior de la escuela primaria, intermedia o preparatoria que se gradúe de la escuela en donde ha
estado asistiendo justo antes de mudarse a otro distrito escolar.
b. Programa especializado de preparatoria: Disponibilidad de un programa especializado de
preparatoria en el distrito de asistencia deseada no existente en el distrito de residencia. Si el
distrito de residencia tiene un programa similar, el alumno no califica bajo esta categoría.
c. Plan para cambiar de residencia: Debe presentarse la evidencia específica y por escrito de que
se va a obtener residencia en el distrito donde se desea la asistencia. Tales permisos no se deben
otorgar por un tiempo de mas de tres meses.
d. Empleo en el distrito escolar: El padre o tutor legal está empleado por el distrito escolar de la
donde se desea la asistencia. Se requiere verificación.
e. Cuidado infantil: Estos son inicialmente otorgados para alumnos en edad de kinder hasta el
grado 8 cuando es imposible hacer arreglos para cuidado infantil o supervisión adecuada en el
distrito de residencia. Se requiere verificación.
3.
Las solicitudes por conveniencia o preferencia personal no serán consideradas.
4.
El transporte es responsabilidad del padre o tutor.
5.
Procedimiento para presentar una solicitud para asistencia Interdistrital:
a.
b.
c.
d.
Llenar la Solicitud para asistencia Interdistrital y llenar los “motivos para la solicitud” en el
espacio proporcionado; proporcionar documentación adicional necesaria; asegurarse de firmar la
solicitud.
Presentar la solicitud para su aprobación ante el administrador autorizado del distrito de
residencia.
Si es aprobada, presentar la solicitud ante el administrado autorizado del distrito en donde se
desea asistir.
El padre o tutor será notificado por correo de la decisión final de su solicitud.
Si tiene alguna pregunta sobre el procedimiento antes descrito, la oficina en la cual obtuvo este
formulario en el distrito escolar de residencia le ayudará.
6.
Un permiso de asistencia Interdistrital es válido únicamente para el año escolar para el cual fue otorgado.
Además, es únicamente válido mientras se mantengan las condiciones indicadas en esta solicitud y
continuará vigente mientras que la asistencia, civismo y beca queden a satisfacción del distrito de
asistencia.
7.
La falsificación de cualquier información presentada en esta solicitud puede ser causa de la revocación
inmediata de una transferencia Interdistrital y ninguna solicitud futura será considerada.
8.
La elegibilidad para la federación atlética Interescolástica (California Interscholastic Federation) para los
grados del 9 al 12 pudieran verse afectados negativamente por esta transferencia. (CIF Southern Section
Blue Book section 206)
PROCESO DE APELACIÓN: DEBE APELARSE ANTE EL DISTRITO QUE HA RECHAZADO LA
SOLICITUD.
28
ENROLLMENT
Lunch Applications (free/reduced)
Lunch applications “free and reduced” meals can be used if a student attends a district school
and identifies themselves as homeless and is in need of a free or reduced price meals.
Definition of ‘homeless’ can be but not limited to:








Homeless Individual (lack of fixed or regular residence)
Children or youth in transitional or Emergency Shelters
Children or youth living in trailer parks and camping grounds
Doubled-up children or youth sharing housing with other family or individual
Runaways
School-aged unwed mothers
Sick or abandoned children or youth
Throwaways
Lunch applications for free/reduced price meals
available on-line
Student Services
Office: (760) 416-6030
Fax: (760) 416-6038
29
ENROLLMENT
Residence Affidavit (Shared Residency)
This document is for compliance with the McKinney-Vento Homeless Assistance Act. The
information provided will help expedite the enrollment process for the student.
The District shall admit only those students who provide proof of district residency. Such
proof shall be required prior to enrollment.
A “Residence Affidavit” may be completed if a parent/guardian is sharing a residence as a
‘temporary address.
This document is for the purpose of enrolling in Palm Springs Unified School District, it does
NOT guarantee enrollment at a specific school site.
PLEASE NOTE: That the District reserves the right to verify the accuracy of the information
on this form and a home visit may be initiated which proves that the parent/guardian is
residing at the stated address mentioned above (EdCode 48204).
Student Services
Office: (760) 416-6030
Fax: (760) 416-6038
Forms available at
30
Residence Affidavit
McKinney-Vento Homeless Assistance Act.
THIS DOCUMENT IS FOR THE PURPOSE OF ENROLLMENT IN PALM SPRINGS UNIFIED SCHOOL
DISTRICT AND DOES NOT GUARANTEE ENROLLMENT AT A SPECIFIC SCHOOL SITE
Student Name
Student’s Date of Birth
(Last)
(First)
Parent/Guardian Name
Parent/Guardian Phone (Day)
(Last)
(First)
Parent/Guardian Address
City
Zip
Student’s ID No.
)
Check:
(
Parent/Guardian Phone (Evening)
(
)
Check:
School
Home
Work
Home
Work
Grade
TO BE COMPLETED BY PARENT/GUARDIAN:
I am the parent/guardian of this student and am now sharing the residence listed at the above address.
This living arrangement is:
Temporary; planned length of stay in this shared residence:
Driver’s license or I.D. card number of parent/guardian:
I declare under penalty of perjury under the laws of California that the foregoing information is true and
correct.
Signature of Parent/Guardian: _____________________________________ Date: ___________________
TO BE COMPLETED BY OWNER/LESSOR/RENTER OF RESIDENCE:
I am the owner/lessor/renter of the residence at the above address and verify that this student and
parent/ guardian are both living full time with me.
Driver’s license or I.D. card number of owner/lessor/renter of residence:
Proof of Residence Required. Proof presented: _______________________________________________
(Utility bill, escrow papers, mortgage statement, rental contract, etc.)
I declare under penalty of perjury under the laws of California that the foregoing information is true and
correct.
Signature of Owner/Lessor/Renter of residence: ________________________________ Date:
____________
Received by:
Date:
Please understand that the District reserves the right to verify the accuracy of the information on this form and a home visit may be initiated which
proves that the parent/guardian is residing at the stated address mentioned31
above. Ed Code 48204.
THIS FORM MUST BE FILLED OUT ANNUALLY
DISTRITO ESCOLAR UNIFICADO DE PALM SPRINGS
Declaración de Residencia
McKinney-Vento Homeless Assistance Act
ESTE DOCUMENTO ES PARA EL PROPOSITO DE INSCRIPCION DENTRO
DEL DISTRITO ESCOLAR UNIFICADO DE PALM SPRINGS Y NO GARANTIZA LA INSCRIPCIÓN EN UNA
ESCUELA ESPECIFICA.
Nombre del estudiante
Fecha de Nac. (alumno)
(Apellido)
(Nombre)
Nombre del Padre/Tutor
Teléfono (durante el día) del Padre/Tutor
(Apellido)
(Nombre)
Domicilio del Padre/Tutor
Ciudad
Código
Número de ID.
(
)
Marque::
Casa
Teléfono (durante la noche) del Padre/Tutor
(
)
Marque:
:
Casa
Escuela
Grado
Empleo
Empleo
DEBE SER RELLENADO POR EL PADRE/TUTOR:
Yo soy el padre/tutor de este estudiante y ahora estoy compartiendo la residencia en el domicilio antes
mencionado.
Este arreglo de vivienda es:
Temporal; el tiempo planeado de estancia en esta residencia es de/hasta:
Licencia de conducir o número de tarjeta de I.D. del padre/tutor:
Declaro que la información provista es leal y verdadera bajo pena de perjurio según lo dispone la ley de
California.
Firma del Padre/Tutor: ___________________________________________ Fecha: ___________________
DEBE SER RELLENADO POR EL DUEÑO /ENCARGADO/RENTERO DE LA RESIDENCIA:
Yo soy el dueño /encargado/rentero de la residencia en el domicilio antes mencionado y verifico que el
alumno y su padre/tutor ambos viven conmigo tiempo completo.
Licencia de conducir o número de I.D. del dueño/encargado/rentero de la residencia:
Se requiere Comprobante de Domicilio. Se presentó: __________________________________________
(Cobro de utilidades, documento de depósito en garantía, factura de hipoteca, contrato de renta, etc.)
Declaro que la información provista es leal y verdadera bajo pena de perjurio según lo dispone la ley de
California.
Firma del dueño/encargado/rentero de la residencia: __________________________ Fecha: ____________
Recibido por:
Fecha:
Por favor comprenda que el Distrito tiene el derecho de verificar la exactitud de la información en este formulario y se puede iniciar una visita
domiciliaria para comprobar que el padre/tutor reside en el domicilio antes mencionado. Código Ed. 48204
ESTE FORMULARIO SE RENOVARA ANUALMENTE
32
PALM SPRINGS UNIFIED SCHOOL
DISTRICT
980 EAST TAHQUITZ CANYON WAY
PALM SPRINGS, CALIFORNIA 92262-0119
(760) 416-6000
FAX (760) 416-6015
CHRISTINE J. ANDERSON Ed.D., Superintendent of Schools
BOARD OF EDUCATION: SHARI STEWART, President –, GARY JEANDRON, Clerk
JUSTIN BLAKE, Member – KAREN CORNETT, Member – RICHARD CLAPP, Member
Enrollment Using Residence Affidavit
Beginning in the 2013-14 school year, schools shall use the following
procedure for NEW students requesting enrollment using the
Residence Affidavit. Students who have been in attendance at a school
site using the Residence Affidavit and requesting to continue at the
school using a Residence Affidavit, will be allowed to remain at their
school site upon providing the appropriate documentation.
The Residence Affidavit is used when a parent is unable to provide proof of
residency and is sharing a residence full-time with another family living within
the Palm Springs Unified School District boundaries. This affidavit is used in
order to be in compliance with the McKinney-Vento Homeless Assistance
Act.
Upon receipt of a Shared Residence Affidavit use the following procedure:
1. Verify that all sections are completed and appropriate documents are
attached.
2. Determine if enrollment is accepted:
a. Yes
Follow enrollment procedures for Homeless Students
(McKinney Vento Homeless Assistance Act)
i. Enroll immediately, regardless of proof of immunization
ii. Document in the SIS the status of “Shared Residence”
or “Homeless”
iii. Fax, scan or email copy of affidavit to Student Services
b. No
Provide the parent with a letter stating the reason for the denial
of enrollment, the Dispute Resolution request form and refer
them to Student Services for school enrollment assistance.
i. Provide parent with assistance in securing an
appointment with Student Services, whenever possible.
33
(760) 416-6000
FAX (760) 416-6015
CHRISTINE J. ANDERSON Ed.D., Superintendent of Schools
BOARD OF EDUCATION: SHARI STEWART, President –, GARY JEANDRON, Clerk
JUSTIN BLAKE, Member – KAREN CORNETT, Member – RICHARD CLAPP, Member
(DATE)
To the Parent or Guardian of: __________________
The Residence Affidavit for enrollment at __________________ has been denied
for the following reason(s):
School Overcrowding
Grade level over enrollment
Per the McKinney-Vento Homeless Assistance Act you may:
 Receive transportation to the school you attended at the point that you
became homeless, or
 Attend another school in Palm Springs Unified School District with
transportation.
For assistance with school placement please contact Student Services at 760416-6032. They will assist you in enrolling in Palm Springs Unified School
District and review your rights.
You have the right to appeal this decision within 10 business days of receiving this
notification by contacting Student Services at 760-416-6032.
Respectfully,
(Principal’s name)
Principal
(School’s name)
34
McKinney-Vento Homeless Assistance Act
Dispute Resolution Rights: Residence Affidavit
1. You may provide written or oral documentation to dispute issues regarding your
child’s school selection or enrollment.
2. You may access a simple dispute form and assistance with any enrollment
dispute by contacting Student Services at 760-416-6032 or by requesting this
form at your school site.
3. You have rights to transportation to your “school of origin” (the school your child
was attending at the point that you became homeless.), within reason.
4. If you are being denied enrollment at your “resident” school due to overcrowding
or over enrollment in a grade level, you have rights to transportation to another
school within Palm Springs Unified School District, as determined by Student
Services.
5. If your dispute of school enrollment is not resolved through the Palm Springs
Unified School District, you may appeal the decision of the district by contacting:
Riverside County Office of Education, Stephan Peace, Coordinator at 951-8266248 or [email protected]
6. While your appeal is being reviewed, you have a right to enroll your child at your
“resident” school while your appeal is under review.
If you have further questions, please contact Student Services at 760-416-6032.
35
Dispute Resolution Request
To: Student Services-Palm Springs Unified School District
Date:
Person completing this form:
Relationship to student:
Contact information:
Written explanation of why you are appealing the enrollment decision for your student(s):
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
______________________________________________________________________
Mail, email or bring this form to:
Student Services-Palm Springs Unified School District
980 E. Tahquitz Canyon Way, Suite 101
Attn: Jane E. Mills, Director
760-416-6032 [email protected]
36
ENROLLMENT
Release of Information
Release of Information form is to be used whenever a non-parent or non-legal
guardian is present in a meeting, hearing or conference being held to discuss
specific student information.
Examples of non-parent or non-legal guardians are as follows:
 Grandparents
 Aunt/Uncle
 Friends of the family
 Step-parents who have not legally adopted the student
 Cousins
 Adult Brother/Sister
Examples of meetings, hearings or conferences where you may need to use
this form are:
 Student Study Team (SST)
 Expulsion hearings
 504 Plan
 Suspension meetings
 Individual Educational Plan (IEP)
 Parent-teacher conferences
 Student Attendance Review Board (SARB)
 Counselor conferences
 Psychologist conferences
 Referrals to Youth Accountability Team (YAT)
Student Services
Office: (760) 416-6030
Fax: (760) 416-6038
Forms available at
37
AUTHORIZATION FOR USE AND/OR DISCLOSURE OF INFORMATION
______________________________________________
_____________________________
__________
Name of student (list other names used)
Medical Record Number (if applicable)
Date of Birth
__________________________________________________________
________________________
____________________
Address of student
Phone No.
Other Phone No.
I authorize the following individual or organization to disclose the above named individual’s medical/educational information as described below:
Individual or Organization Disclosing Information:
Individual or Organization Receiving Information:
____________________________________________________
________________________________________________
Disclosing party
Receiving party
__________________________________________________________
Address
______________________________________________________
Address
__________________________________________________________
City, State, Zip Code
_______________________________________________________
City, State, Zip Code
Telephone: _______________________ Fax: _____________________
Telephone: ________________________ Fax: _________________
Duration:
This authorization shall become effective immediately and shall remain in effect until ________________ (date) or
for one year from the date of signature if no date is entered.
Revocation:
I understand that I have the right to revoke this authorization, in writing, at any time by sending such written
notification to the releasing agency. Written revocation will be effective upon receipt, but will not apply to information
that has already been released in response to this authorization.
Redisclosure:
I understand that health information used or disclosed pursuant to this authorization may be subject to redisclosure
by the recipient and it is no longer protected by federal laws and regulations regarding the privacy of protected health
information. I further understand the confidentiality of the information when released to a public educational agency is
protected as a student record under the Family Educational Rights and Privacy Act (FERPA).
Health Info:
I understand that authorizing the disclosure of health information is voluntary. I can refuse to sign this authorization. I
do not need to sign this form in order to assure medical treatment.
Specify:
Record(s):
Indicate type of information is to be disclosed;
 Medical Information
 Medication Information
 Psychiatric Information
 Mental Health
 Drug/Alcohol Information
 STD/HIV Test Results
 Education Records
 Other:
I request that the information pursuant to this authorization be for the following purposes only:
 Educational Assessment
 Education Planning
 Other: ______________________________________________
______________________________________________________________________________________________________________________
A copy of this authorization is as valid as an original.
I understand that I have a right to receive a copy of this authorization for my records.
____________________________________________________
Signature of Student or Student’s Representative
______________________________________________ _______________
Description of Relationship to Student
Date
Revised: September 2003
38
DISTRITO ESCOLAR UNIFICADO PALM SPRINGS
CONSENTIMIENTO PARA EL USO Y/0 REVELACION DE INFORMACION
______________________________________________
_____________________________
Nombre del estudiante (enliste los nombres usados)
Número del archivo Médico (si aplica)
__________
Fecha de Nacimiento
__________________________________________________________
________________________
____________________
Dirección del estudiante
No. de teléfono
Otro No. de teléfono
Autorizo al siguiente individuo u organiazación a que revele la información médica/educativa del individuo mencionado anteriormente como esta
descrito abajo.
Individuo u Organización Dando la Información:
Individuo u Organización Recibiendo la Información:
____________________________________________________
________________________________________________
Persona dando la información
Persona recibiendo la información
__________________________________________________________
Dirección
______________________________________________________
Dirección
__________________________________________________________
Ciudad, Estado, Código Postal
_______________________________________________________
Ciudad, Estado, Código Postal
Teléfono: _______________________ Fax: _____________________
Teléfono: ________________________ Fax: _________________
Duración:
Está autorización será efectiva inmediatamente y se mantendrá en efecto hasta el _____ (fecha) o
Por un año de la fecha de la firma sí es que no es fechada.
Revocación:
Entiendo que tengo el derecho de revocar esta autorización, por escrito, en cualquier momento enviando dicha
notificación a la agencia que esta inforrmando. La revocación por escrito será efectiva al momento de ser recibida,
pero no aplicará a la información que ya sea a dado en respuesta a esta autorización.
Re-revelación:
Entiendo que la información obtenida tocante a esta autorización puede estar sujeta a ser proveida por el que la
recibe y ya no esta protegida por leyes federales y acerca de regulaciones de protección de privacidad de
información de salud. Yo entiendo que la confidencialidad de la información cuando es dada a una agencia educativa
publica esta protegida como archivo del estudiante bajo los Derechos Educativos de la Familia y el Acta de
Privacidad (FERPA).
Info. De Salud:
Entiendo que la autorización de revelación de información de salud es voluntaria. Que me puedo rehusar a firmar
esta autorización. Que no necesito firmar esta forma para asegurar tratamiento médico.
Especifique:
Archivo(s):
Indique el tipo de información que será revelada;
 Información médica
 Información de medicamento
 Información psíquiatrica
 Salud Mental
 Información de Droga/Alcohol
 Resultados de examenes de EST/SIDA
 Archivos Educativos
 Otro:
Pidó que la información dada tocante a esta autorización sea para los siguientes propositos únicamente:
 Evaluación Educativa
 Plan Educativo
Otro: ______________________________________________
______________________________________________________________________________________________________________________
Una copia de esta autorización es tan valida como un original.
Entiendo que tengo el derecho de recibir una copia de esta autorización para mi archivo.
____________________________________________________
Firma del estudiante o del Representante del Estudiante
______________________________________________ _______________
Descripción de Parentesco con el estudiante
Fecha
Revised: September 2003
39
DISCIPLINE
Expulsion Process
EXPULSION PROCESS:
 For any student expulsion referral, school sites must fax a ‘Principal signed Suspension
Notice’ to Student Services office at (760) 416-6038 (using the ‘Confidential’ fax cover
sheet).
 If requesting an “Extension of Suspension” meeting, a fax must also be sent to Educational
Services at (760) 416-6075. Please call Educational Services at (760) 416-6055 to set up
date/time of extension meeting.
Note: Extension of suspension meetings must be held within days of suspension.
IMPORTANT: Special Education/504 expulsion referrals require a “Manifestation of
Determination” meeting within 10 days of first day of suspension, to proceed with the
expulsion process. (See Expulsion flow chart )
Expulsion Packet Includes:
Request for Waiver of Hearing Packet:
Expulsion Packet Contents Order
Due Process Documentation
Student Summary
School’s Recommendation Page
Counselor’s Report (MS/HS)
Student’s Incident Statement
Copy of Suspension Notice of Incident
Administrative Review Inquiry
Detailed Discipline Report
Student Profile (including grades/test scores)
Current Attendance Report
School Transcripts
Parent Information Bulletin
Waiver Request Form
Principal Check-list
Waiver Expulsion Packet*
(*same as regular expulsion packet)
Students expelled from other District:
Contact Student Services (760) 416-6029 for
guidelines.
Board Policy –Discipline 5144, 5144.1(a-c), AR5144.1(a-x) and AR5144.2(a-i)
Ed Code 48915(a)(1, 2, 3, 4, 5) - Mandatory Recommendation for Expulsion (with-exception)
Ed Code 48915(c)(1, 2, 3, 4, 5) - Mandatory Recommendation for Calendar Year Expulsion (no-exception)
Student Services
Office: (760) 416-6030
Fax: (760) 416-6038
Forms available at
40
FLOW CHART
Determination of Conduct in
Violation of EC 48900
48900, .2, .3, .4, .7
Day One
Special Education Students
General Education Students
SUSPENSION
Not more than 5 school days. (EC 48911)
Suspension limited to 10 consecutive
school days or less, e.g., 5 days
suspension + 5 days Extension of
Suspension (EC 48911(a) and (g))
Expellable
Not Expellable
RECOMMENDATON FOR EXPULSION
EXTENSION OF SUSPENSION
(EC 48915) additional 5 school days [spec.ed./504 student],
extension of suspension pending decision on expulsion.
[gen.ed.studetn]. (EC48911(g))
Expellable
Not Expellable
10 school Days
Assessment Plan for Possible
Disciplinary Change in Placement
Evaluation sent to Parent, if necessary
Possible Disciplinary Change
in Placement Assessment
Conducted, if necessary
Notification of Manifestation Determination
IEPTeam Meeting
PUPIL REQUEST FOR
OPEN HEARING
Within 5 calendar days preceding
Hearing. (EC48818(c))
DISTRICT EXTENSION OF
HEARING DATE
Up to 5 school days
“for good cause.”
(EC 48918(a))
PUPIL POSTPONEMENT
Entitled to not more than one
postponement – not to exceed
30 calendar days
- - additional days at
Board’s discretion.
(EC 48919(a))
HEARING
To be conducted within 30 school
days of determination of pupil
violation. (EC 48918(a))
NOTE: Special Hearing
Procedures (EC 48918.5)
Manifestation Determination IEP Team Meeting
Review now Assessment, if conducted, existing
evaluation and diagnostic results, observation, IEP
and Placement; discipline records, existing BIP
If no BIP, develop assessment plan
for functional behavior analysis and develop
behavior plan
* IEP needs to be modified
* Behavior is related to disability
* Placement and services
inappropriate
* IEP not implemented
NOTICE OF HEARING
At least 10 calendar days
prior to hearing.
(EC48918(b))
ADMINISTRATIVE
PANEL or HEARING
OFFICER
RECOMMENDATION
Within 3 school days or
by 33rd school day without
postponements.
(EC48918(e))
Setting date for review for
re-admission and
recommendation of
rehabilitation plan.
(EC 48916)
Post expulsion education
program. (EC 48919)
* Behavior is not related
to disability
* Placement & Services
appropriate
* IEP is appropriate
No Expulsion
Address Placement
Services and BIP
APPELLATE HEARING
Within 20 school days
following filing of
formal request. (EC 48919)
Forward to Expulsion
DECISION OF
GOVERNING BOARD
Within 10 schooldays: or 40th
school day without pupil
requested hearing
postponement. (EC 48918(i))
APPEAL TO COUNTY
BOARD
Within 30 calendar days
following local board
decision. (EC 48919)
DECISION OF THE
COUNTY BOARD
Within 3 school days of hearing,
absent pupil
request for postponement
(EC 48919)
504 Students with 504 Plan
Determination of Conduct in
Violation of EC 48900, 48900, .2, .3, .4, .7 - Day One
Notification of Manifestation Determination
504 Team Meeting to review assessment and
504 Plan accommodations and services
Manifestation Determination
504 Team Meeting Review Assessment
Review 504 Plan
Suspension
Limited to 10 consecutive school days or less, e.g.,
5 days suspension + 5 days extension (EC 48911 (a) & (g))
Not Expellable
Possible Disciplinary
Change of Placement
Assessment Conducted
Expellable
Assessment Plan for Possible Disciplinary
Change in Placement and
Assessment Sent to Parent
NO EXPULSION
If 504 Plan not implemented or
Behavior related to disability
© June 2003 Atkinson, Andelson, Loya, Ruud & Romo
41
FORWARD TO EXPULSION
504 Plan Implemented
Behavior not related to Disability
(student’s name)
EXPULSION PACKET CONTENTS ORDER
TO BE PROVIDED BY THE SCHOOL:
1.
COVER SHEET
2.
DUE PROCESS STATEMENT
3.
EXPULSION HEARING STUDENT SUMMARY
4.
SUMMARY OF INTERVENTIONS
5.
RECOMMENDATION PAGE
6.
COUNSELOR’S REPORT
7.
EXIT INTERVIEW
8.
PARENT CONFERENCE
9.
COPY OF STUDENT INCIDENT STATEMENT
10. COPY OF SUSPENSION NOTICE FOR INCIDENT
11. XEROX PICTURE OF ANY EVIDENE (I.E.: WEAPON, DRUGS, ETC.)
12. TEACHER INQUIRIES
13. DISCIPLINE REPORT (HISTORY OF MIDDLE AND HIGH SCHOOL AND SIGNIFICANT
ELEMENTARY INCIDENTS)
14. INFORMATION ON:
DATE OF ENROLLMENT
SCHOOLS ATTENDED
TRANSFERS
READING GRADE LEVEL
LEVEL OF ENGLISH PROFICIENCY
CURRENT GRADES AND G.P.A.
MOST RECENT STANDARDIZED TEST SCORES
CURRENT ATTENDANCE RECORD
TO BE ADDED BY STUDENT SERVICES:
15. STATEMENT OF CHARGES
16. EXTENSION OF SUSPENSION LETTER
17. DATE OF HEARING LETTER
18. RECEIPT OF DATE OF HEARING LETTER
TO BE PRESENTED AT EXPULSION HEARING:
19. INTRODUCTION OF ADDITIONAL ADMISISTRATIVE EXHIBITS
20. WITNESS STATEMENT(S)
42
DUE PROCESS DOCUMENTATION
Instructions: This form is to be filled with you expulsion case. Statement of witnesses, District
memoranda, and other documents may be attached.
I request that the records show that due process has been properly followed, that the Governing Board
jurisdiction is clear in procedural compliance in this case, and the suspension imposed, the date on which
imposed and the grounds as listed in the charges under Education Code 48900 are legal.
School: _________________________________________
Date: ________________________
Student: ________________________________________
Violation of Education Code: _______________________
Specific Incident Date: ______________________________________
Reported by: ______________________________________________
Brief Statement:
Principals Exit Interview with Student EC 48911(b)(c)
Date: ______________________________
Place: ______________________________
Person Present: __________________________________
Time: _______________________
Immediate Action Taken:
Notification of Law Enforcement:
Date: __________________________
Suspension by: ____________________________ Dates: _________________________
Notification of Parents and Request to Attend Conference:
By Telephone: _____
Date: _____________________
By Letter: ________
Date: _____________________
Principal/Parent Conference EC 911(f)
Present at Conference: _________________________________________________________
Recommended Action EC 48915 (a)(b)(c)
Expulsion: ___________________
Other: ______________________
If other, describe recommended disposition.
Extension of Suspension Granted:
YES________
If other, describe recommended disposition:
43
NO _______
HEARING DATES: ___________
PANEL: _____________________
SCHOOL BOARD_____________
EXPULSION HEARING
STUDENT SUMMARY
STUDENT NAME: ______________________________
D.O.B. __________
SCHOOL OF ATTENDANCE: ____________________________________________
GRADE: ___________________
DATE OF INCIDENT: ___________________________
WITNESS(ES): _________________________________
FOR: ____________________________________
AGAINST: _______________________________
INDICENT STATEMENT:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
STUDENT’S INCIDENT STATEMENT:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
44
EXPULSION HEARING RECOMMENDATION
STUDENT NAME: _______________________________
RECOMMENDATION OF REFERRING SCHOOL PRINCIPAL:
FULL EXPULSION
Yes
No
Yes
Yes
No
No
Yes
No
Fall Semester
Spring Semester
Yes
Yes
No
No
Year: ________
Year: ________
CALENDAR YEAR
Yes
No
Ending: ______
Fall Semester
Spring Semester
SUSPENDED EXPULSION
Year: ________
Year: ________
CONDITIONS REQUIRED IN SUSPENDED EXPULSION OR FULL EXPULSION:
8 COUNSELING SESSIONS
COMMUNITY SERVICE--TOTAL HOURS _____
DRUG COUNSELING
OTHER ________________________________
ACADEMIC/ATTENDANCE/BEHAVIOR CONTRACT (for suspended expulsions)
RATIONALE:
______________________________
SCHOOL PRINCIPAL
45
Student Description of Incident Statement
School: ___________________
Student Name: ____________________ Grade: _______ Date of Incident: _________
Type of Incident: _______________ Location of Incident: _________________
Who was involved in this incident? __________________________________________
_______________________________________________________________________
How were you involved in this incident? ______________________________________
_______________________________________________________________________
How did the incident start? ________________________________________________
_______________________________________________________________________
What happened during the incident: _________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
How did the incident stop? ________________________________________________
_______________________________________________________________________
Who else should we talk to about this incident? ________________________________
Other details: ___________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Are you willing to testify and/ or have your identity disclosed at any hearing regarding
the above incident?
 Yes
 No. Why not? _____________________________________________
_______________________________________________________________________
All of the information I have given you is true and correct.
Signature: __________________________
Date: _______________
Print Name: _________________________
Witnessed By: __________________________________
Title: _________________________________________
46
ADMINISTRATIVE REVIEW INQUIRY
SCHOOL: __________________________________
Date: __________________________
Student: _______________________________________
Teacher: ______________________
Teacher: ______________________
Teacher: ______________________
Teacher: ______________________
Teacher: ______________________
Teacher: ______________________
We are preparing for a hearing regarding the possible expulsion of the student
named above. Please provide your objective written comments (using black ink
only) regarding this student in the areas listed below. Your comments are critical in
determining the most appropriate educational placement for this student.
Please return this form to the office by __________________.
___________________________________________________________________
ATTENDANCE:
ACADEMIC PROGRESS:
BEHAVIOR:
47
Palm Springs Unified School District
REQUEST FOR WAIVER OF ADMINISTRATIVE HEARING
Student Expulsion Process
To:
Director, Pupil Personnel Services
RE:
_________________________________________________
Student Name
_________________________________________________
School
_________________________________________________
Principal Recommending Expulsion
We/I have been informed of and understand the right to due process with regard to the expulsion
recommendation made by my/our son/daughter’s school principal. In particular, I/we have been informed and
understand that my/our son/daughter has the right to a full evidentiary hearing; the right to appear in person
and/or employ and be represented by legal counsel or a nonattorney advisor at this hearing; the right to inspect
and obtain copies of all documents to be used at the hearing; the right to confront and question all witnesses
who testify at the hearing; the right to question all other evidence presented; and the right to present oral and
documentary evidence on my/our son/daughter’s behalf, including witnesses.
I/We have received written copy of these rights. I/We have also received and fully reviewed a written
description of the charges that led to the recommendation for expulsion. A copy of the written description of
the charges is included in the “Palm Springs Unified School District Suspension” form, which is attached to
this waiver and incorporated by reference herein. I/We accept the description of the incident contained in the
statement of charges as accurate and grounds for expulsion under the California Education Code. We
understand the schools recommendation and recommended readmission plan.
After careful consideration, I/we request a waiver of the expulsion hearing before a district administrative panel
and the right to the due process proceedings. I/We also waive the legal timeline requirements that govern the
expulsion process.
I/We understand that an expulsion recommendation pursuant to the Education Code sections on student
suspension and expulsion (Education Code Section 48900 et seq.) will be submitted to the Board of Education
for its review and final action. I/We understand that the Board of Education’s decision is not restricted to the
Principal’s recommendation. I/We also understand that I/we may be present when the Board of Education
discusses the recommendation and that I/we may make a statement in support of the Principal’s
recommendation.
Signed, _____________________________________
(Student)
____________________________________
Date
(Parent/Guardian)
Date
_____________________________________
____________________________________
(Parent/Guardian)
(Principal)
Date
Date
Revised 8/20/02
For Office Use
Received On: _____________________
Waiver Request Approved: Yes______
Signed: ____________________________________________________
Director, Pupil Personnel Services/Designee
48
No______
Distrito Escolar Unificado de Palm Springs
SOLICITUD DE RENUNCIA A UNA AUDIENCIA ADMINISTRATIVA
Proceso de Expulsión del estudiante
A:
Director de Personal de Servicios Estudiantiles
Acerca
De:
______________________________________________________
Nombre del Estudiante
_____________________________________________________
Escuela
_____________________________________________________
Director Recomendando la Expulsión
Nosotros/yo he sido informado y entiendo el derecho al proceso acerca de la recomendación de expulsión hecha por el director de
la escuela de mi hijo/a. En particular hemos/he sido informado y entiendo que mi hijo/a tiene el derecho a una audiencia
evidenciad completa, el derecho de aparecer en persona y/o emplear o ser representado por un consejero legal o un asesor legal
no-abogado en esta audiencia; el derecho a revisar y obtener copias de todos los documentos que serán usados en la audiencia; el
derecho a enfrentar e interrogar a todos los testigos que declararan en la audiencia; el derecho de cuestionar toda la demás
evidencia presentada, y el derecho a presentar evidencia oral y documentada a favor de mi hijo/a incluyendo testigos.
Nosotros/yo he recibido copias escritas de estos derechos. Nosotros/yo también recibí y revise bien una descripción por escrito
de los cargos que llevaron a la recomendación para la expulsión. Una copia de la descripción por escrito de los cargos esta
incluida en la forma de “Suspensión del Distrito Escolar Unificado de Palm Springs” la cual esta adjunta a esta renuncia e
incorporada por referencia aquí dentro. Nosotros/yo acepto la descripción del incidente contenido en la declaración de cargos
como correcta y los fundamentos para la expulsión bajo el Código Educativo de California. Entiendo la recomendación de la
escuela y el plan de readmisión recomendado.
Después de la consideración cuidadosa, nosotros/yo pido la renuncia a la audiencia de expulsión ante un panel administrativo del
distrito y el derecho al proceso de ley. Nosotros/yo también renuncio a los limites de tiempo requeridos que guiá el proceso de
expulsión.
Nosotros/yo entiendo que una recomendación de expulsión de acuerdo a las secciones en el Código Educativo en la suspensión o
expulsión de un estudiante (Código Educativo sección 48900 et seq.) será enviada a la Mesa Directiva para su revisión y acción
final. Nosotros/yo entiendo que la decisión de la Mesa Directiva no esta restringida a la recomendación del director. Nosotros/yo
también entiendo que nosotros/yo puedo estar presente cuando la Mesa Directiva discuta la recomendación y que nosotros/yo
puedo hacer una declaración en apoyo a la recomendación del director.
Firmada, ________________________________________
(Estudiante)
Fecha
________________________________________
(Padre/Tutor)
Fecha
____________________________________________________
(Padre/tutor)
Fecha
_____________________________________________________
(Director)
Fecha
Para el Uso de la Oficina
Fecha: _______________________
Aprobación de la Solicitud de Renunciá:
Firmado: __________________________________________________________
Director del Personal de Servicios Estudiantiles/Designado
49
Sí _________
No _________
Palm Springs Unified School District
PARENT INFORMATION BULLETIN
Parent/Guardian Request for Waiver of Administrative Hearing
Student Expulsion Process
Under the California Education Code, all students recommended for expulsion are entitled to an impartial hearing. The
Education Code also governs the timeline of steps taken to consider a recommendation for expulsion. The Palm Springs
Unified School District respects and complies with the timeline and fact finding requirements prescribed in the California
Education Code.
In certain expulsion cases, students and their parents/guardians wish to expedite the expulsion process by waiving their
right to the expulsion hearing and the timeline governing the expulsion process. When parents/guardians make such a
request, an alternative process that eliminates the need for an expulsion hearing and expedites the timeline may be used.
The advantages of this process include:


Expedited placement of the student in an alternative educational program.
Elimination of the need for the student and parent/guardian to appear at an administrative hearing to review
the incident that led to the expulsion recommendation.
A request to waive an administrative hearing and the timeline requirements can be considered when:



The student and parent/guardian do not dispute the charges, which led to the recommendation for expulsion.
The student acknowledges responsibility for his/her behavior.
The charges/allegations against the student require/mandate an expulsion recommendation by the
principal/Superintendent, the hearing officer, or the administrative hearing panel.
A request to waive the expulsion hearing will be approved when it is determined that the alternative process is in the best
interest of the student and district.
The parent is to contact the Principal/designee to request access to the “Waiver of Hearing” process within 10 days
of the first day of their student’s suspension. A meeting will be set up with the Principal/designee within 3 working
days of the parent request.
A “Request for Waiver of Administrative Hearing” form must be signed by the parent/guardian, student and Principal and
submitted to the Director of Pupil Personnel Services by the Principal/designee to initiate this process.
If the Director of Pupil Personnel Services approves the request for a “Waiver of Administrative Hearing”, it will be
submitted to the Palm Springs Unified School District Board of Education. The parents/guardians make a knowing and
voluntary waiver of their right to have an expulsion hearing and therefore:






Waive the right to all notices and timelines required by statute, rule or regulations;
Waive the right to be represented by legal counsel or a non-attorney advisor at such expulsion hearing;
Waive the right to inspect and obtain copies of documents which would have been used at the hearing and
which will be presented to the District’s Board of Education as part of its review of the expulsion
recommendation and final action.
Waive the right to confront and question all witnesses who would have testified at the hearing;
Waive the right to question all other evidence presented which would have been presented at the hearing and
which will be presented to the District’s Board of Education as part of its review of the expulsion
recommendation and final action.
Waive the right to present oral and documentary evidence on the student’s behalf including witnesses.
Revised 8/20/02
50
Distrito Escolar Unificado de Palm Springs
BOLETIN DE INFORMACION PARA LOS PADRES
SOLICITUD DE RENUNICA DEL PADRE/TUTOR A UNA AUDIENCIA ADMINISTRATIVA
Proceso de Expulsión del Estudiante
Bajo el Código Educativo de California, todos los estudiantes recomendados a ser expulsados tienen el derecho a una audiencia
imparcial. El Código Educativo también guiá la limitación de tiempo de los pasos a seguir para considerar una recomendación para la
expulsión. El Distrito Escolar Unificado de Palm Springs respeta y cumple con la limita tiempo y los requisitos de los hechos
encontrados prescritos por el Código Educativo de California.
En ciertos casos de expulsión, sí el estudiante o su padre(s)/tutor(es) desean acelerar el proceso de expulsión renunciando a su derecho a
la audiencia de expulsión y al proceso en la limita tiempo requerido. Cuando los padres hacen dicha petición, un proceso alterno el cual
elimina la necesidad de una audiencia de expulsión y acelera la limita tiempo que se puede usar. Las ventajas de este proceso incluyen:


Acelera la colocación del estudiante en un programa de educación alterna.
Evita la necesidad de que el estudiante y su(s) padre(s)/tutor(es) se presenten ante una audiencia administrativa para
revisar el incidente que lo llevo a la recomendación de expulsión.
Una solicitud para renunciar a la audiencia administrativa y los requisitos del limite de tiempo podrán ser considerados cuando:



El estudiante y el padre/tutor no disputan los cargos, los cuales llevaron a la recomendación para la expulsión.
El estudiante reconoce la responsabilidad por su conducta.
Los cargos/alegaciones en contra del estudiante requiere/exija la recomendación de su expulsión por el
director/Superintendente, el oficial de audiencias o el panel de audiencias administrativas.
Una solicitud de renuncia a la audiencia administrativa será aprobada cuando se determine que el proceso alternativo es lo mejor para el
estudiante y el distrito.
El padre debe ponerse en contacto con el director/designado para solicitar el acceso al proceso de “Renuncia a una Audiencia”
dentro de los primeros 10 días de la suspensión del estudiante. Una reunión será programada con el director/designado dentro
de 3 días laborables del día de la solicitud del padre.
Una solicitud de “Petición de Renuncia a una Audiencia Administrativa” debe ser firmada por el padre/tutor, el estudiante y el director y
ser entregada al Director de Personal de Servicios Estudiantiles por el director/designado para dar inicio a este proceso
Sí el Director del Personal de Servicios Estudiantiles aprueba la solicitud para la “Renuncia a la Audiencia Administrativa” esta será
enviada a la Mesa Directiva del Distrito Escolar Unificado de Palm Springs. El padre(s)/tutor(es) ha hecho una renuncia voluntaria
sabiendo de su derecho a tener una audiencia de expulsión por lo cual:






Renuncia a los derechos a todos los avisos y limites de tiempo requeridos por el estatuto, reglas y regulaciones;
Renuncia al derecho de ser representado por un consejero legal o un consejero no-abogado en dicha audiencia de
expulsión;
Renuncia al derecho de obtener copias y a la revisión de los documentos los cuales hubieran sido utilizados en la
audiencia y los cuales serán presentados a la Mesa Directiva del Distrito como parte de la revisión de la expulsión y
acción final.
Renuncia al derecho de enfrentar e interrogar a todos los testigos quienes hubieran declarado en la audiencia.
Renuncia al derecho a cuestionar toda la demás evidencia presentada la cual hubiera sido presentada en la audiencia la
cual será presentada a la Mesa Directiva del Distrito como parte de su revisión de la expulsión y de la acción final.
Renuncia al derecho de presentar evidencia documentada y oral a favor del estudiante incluyendo testigos.
Revisión 8/20/02
51
PRINCIPAL'S CHECKLIST: WAIVER OF ADMINISTRATIVE HEARING OPTION
To be completed as part of the recommendation for expulsion.
_________________________________________
__________________________________ ____________
Student Name
A.
School
Grade
DOB
Discretionary Expulsion
______ 1.
The facts of the incident are agreed to by school personnel, the student and the student’s parent/guardian.
The facts regarding the incident are not contested, unclear or in dispute.
______ 2.
The principal agrees that the “Waiver of Hearing” is an appropriate option in this case.
______ 3.
The “Waiver of Hearing” is in the best interest of the student and the district.
The recommendation for expulsion is also made because of the following supplemental findings:
_____ Other means of correction are not feasible or have repeatedly failed to bring about appropriate conduct.
Detail:
_____________________________________________________________________________________
_______________________________________________________________________
_____ Due to the nature of the act, the presence of the pupil causes a continuing danger to the physical safety of
the pupil or others. Detail:
_____________________________________________________________________________________
_______________________________________________________________________
-ORB.
Mandatory Expulsion
______ 1.
The facts of the incident are agreed to by school personnel, the student and the student’s parent/guardian.
The facts regarding the incident are not contested, unclear or in dispute.
______ 2.
The student violated one of the following: (please circle)
_______ 3.
a.
Possessed, sold or otherwise furnished a firearm.
b.
Brandished a knife at another person.
c.
Unlawfully sold a controlled substance listed in Chapter 2 (commencing with Section 11053) of
Division 10 of the Health and Safety Code.
d.
Committed or attempted to commit a sexual assault as defined in subdivision (n) of Section
48900 or committed a sexual battery as defined in subdivision (n) of Section 48900.
e.
Possession of an explosive device (effective January 2002 as defined in Sections 240 & 242 of
the Penal Code).
The principal agrees that the stipulated expulsion is an appropriate option in this case.
Complete this checklist and send to the Director of Pupil Personnel Services.
_____________________________________________________________
Principal Signature
_____________________________________________________________
Date
Revised 8/20/02
52
DISCIPLINE
Law Enforcement-Access to Students
Law Enforcement Officers have a right to access students on a campus in
carrying out their duties in relation to an investigation of a juvenile crime.

It is good practice for school site to contact parents of students
interviewed once the investigation has been cleared with the police
officer.

It is standard operating procedure that a law enforcement officer check
in with the principal before contacting a student.
Student Services
Office: (760) 416-6032
Fax: (760) 416-6038
53
DISCIPLINE
Notification of Law Enforcement
Per Education Code 48902 and 44014 the following incidents are required to be reported to
Law Enforcement at the time of discipline or suspension from school.
E.C. 48900:
48900(a)(2) Willfully used force or violence upon the person of another, except in selfdefense.
48900(b) Possessed, sold or otherwise furnished any firearms, knife (over 2-1/2 in.),
explosive, or other dangerous object.
48900(c)
Unlawfully possessed, used, sold, or otherwise furnished or been under the
influence of any controlled substance, alcoholic beverage or intoxicant of any
kind.
48900(d) Unlawfully offered, arranged, or negotiated to sell any controlled substance,
alcoholic beverage, or intoxicant of any kind, and then either sold, delivered or
otherwise furnished anything in lieu of it and represented the replacement as a
controlled substance alcoholic beverage or intoxicant.
48900(j)
Had unlawful possession of, unlawfully offered, arranged or negotiated to sell any
drug paraphernalia.
48900.7
Made terrorist threats against school officials or property, or both.
For more information, please contact
Student Services at (760) 416-6030:
Student Services
Office: (760) 416-6030
Fax: (760) 416-6038
54
DISCIPLINE
Suspension Notification
BP-5144.1(a)
The Governing Board recognizes that maintaining an environment which promotes learning
and protects the health, safety and welfare of all students may require the suspension or
expulsion of a student from regular classroom instruction. District policies and school site
rules shall clearly identify District behavior standards.
Suspension:
Except in cases where suspension for a first offense is warranted in accordance with law,
Education Code 48900(a-e) violations, suspension shall be imposed only when other means
of correction fail to bring about proper conduct. (Education Code 48900.5)
Each principal shall annually inform all students and parents/guardians of the school’s
discipline rules and procedures and of the availability of all District policies and regulations
dealing with student discipline, suspension and expulsion. (Education Code 35291, 35291.5)
Suspended or expelled students shall be excluded from all school-related extracurricular
activities during the suspension or expulsion.
Student Due Process:
The Board shall provide for the fair treatment of students facing suspension and expulsion by
affording them their due process rights under the law. The administration and staff shall
comply with procedures for notices and appeals as specified in regulation. Procedures
governing student due process shall conform in all aspects to provisions in law. (Education
Codes 48911, 48915 and 48915.5)
Guidelines for Student Behavior (Discipline Action) chart available on Web-site.
Student Services
Office: (760) 416-6030
Fax: (760) 416-6038
55
ARSON: Intentional burning of property
MEETING/SUSPENSION
SUSPENSION/EXPULSION
CONFERENCE/MEETING/DETENTION
CONFERENCE/MEETING/DETNTION
Min
Max
Min
Max
Min
Max
Min
Max
EXPLOSIVE DEVICES: The use, possession or
sale of explosive devices
ALCOHOL: The use possession or sale of
alcoholic substance
DEFIANCE OF SCHOOL PERSONNEL’S
AUTHORITY: Refusal to comply with reasonable
request of school personnel
DRUGS: Possession of drug paraphernalia, sale
furnishing, or use of controlled substance or their
look alikes
56
DESTRUCTION OR DEFACEMENT OF PROPERTY:
Attempting to damage, destroy, or mutilate objects or
materials belonging to the school, school personnel or
other persons
DETENTION/PARENT NOTICE/SATURDAY
SCHOOL
SARB/CONTINUATION/OPPORTUNITY
Min
UNEXCUSED ABSENCES AND CUTTING: Any
absence which has not been both excused by a
parent or legal guardian and approved by the
appropriate school official
SUSPENSION
EXPULSION
Min
Max
Min
Max
PHYSICAL ASSAULT: Physical attack of one
person, or of a group of persons, upon another
person with who does not wish to engage in the
conflict
HATE VIOLENCE: Oppress, intimidate. Cause or
threatened to cause injury to another person or
their property based upon race, color, religion,
ancestry, national origin or sexual orientation
SUSPENSION
EXPULSION
EXTORTION/ROBBERY: Solicitation of money, or
something of value, from another person, in return for
protection or in connection with a threat to inflict harm
or robbing a person
SUSPENSION
EXPULSION
Min
Max
SEXUAL ASSAULT: Committed or attempted to
commit a sexual assault
DISORDERLY CONDUCT, INCLUDING PROFANITY
AND OBSCENE BEHAVIOR: Conduct and/or
behavior which is disruptive to the orderly educational
procedure of the school including habitual profanity or
vulgarity
E. C. 48915C
1)
Selling drugs
2) Brandishing a knife
2)
Possessing, selling or furnishing a firearm
3)
Committing or threatening or commit sexual
assault
Expulsion may occur on first offense unless justified by district.
WITNESS: Harassed, threatened or intimidated a
pupil who is a complaining witness or witness in a
school disciplinary proceeding.
SUSPESION
EXPULSION
Min
Max
IMITATION FIREARM: Possession an imitation
firearm
Max
INTENTIONAL HARASSMENT: Threatened or
intimidated a student or group of students to the extent
of creating an intimidating or hostile education
environment
MEETING/SUSPENSION
EXPULSION
Min
Max
SMOKING/TOBACCO POSSESSION: The use or
possession of tobacco of any kind on school property
or at school activities
FIGHTING: Engaging in or threatening physical
contact for the purpose of inflicting harm on another
person
SEXUAL HARASSMENT: Unwelcome sexual
advances and other verbal, visual or physical
conduct of a sexual nature
SUSPESNION
EXPULSION
THEFT: Receiving, attempting to take property that
doesn’t belong to you
CONFERENCE/MEETING
SUSPESION/LOSS OF BUS PRIVILEGES
Min
Max
BUS CONDUCT: Not following bus rules
WEAPON/DANGERUS OBJECTS: Use, possession
of furnishing of any knife, firearm, or other dangerous
object
FORGERY: Using signature or initials of a teacher or
parent
CONFERENCE/MEETING
SUSPENSION/LOSS OF BUS PRIVILEGES
Min
Max
VERBAL ABUSE: Statements which, intimidate or
injure another person
DRESS CODE: Failure to observe the school’s dress
code
BEING IN RESTRECTED AREA: Failure to adhere to
school rules
CONFERENCE/MEETING
DETENTION/ISS
CONFERENCE/DETENTION
SATURDAY SCHOOL
Min
Max
Min
Max
PROBLEM AREAS
POSSIBLE ACTIONS TO BE TAKEN
PREPAREDNESS: Unprepared with necessary
materials/assignments
TARDINESS: Arriving late to class
PROBLEM AREAS
RELATIONSHIP BETWEEN PROBLEM AREA AND DISCIPLINARY ACTION
SUSPENSION
EXPULSION
Min
Max
School site must recommend a calendar year
expulsion. Board of Education may impose a
lesser consequence
SUSPENSION
EXPULSION
SUSPENSION
EXPULSION
CONFERENCE/MEETING
CONFERENCE/MEETING
EXULSION
MEETING/CONFERENCE/ISS
SUSPENSION
CONFERENCE/SUSPENSION
SUSPENSION EXPULSION
SUSPENSION
EXPULSION
MEETING/SUSPENSION
EXPULSION
MEETING
SUSPENSION/EXPUSLION
MEETING
DETENTION/SUSPENSON
CONFERENCE/MEETING
SUSPENSION
INFORMAL TALK/FORMAL CONF.
DETENTION/ISS
Min
Max
Min
Max
Min
Max
Min
Max
Min
Max
Min
Max
Min
Max
Min
Max
Min
Max
Min
Max
Min
Max
Min
Max
POSSIBLE ACTIONS TO BE TAKEN
(NOTE: A school may have additional rules/regulations unique to a particular campus, i.e. age, severity, and frequency of the action)
E. 5144.1 (c)
DISCIPLINE
Teacher Notification of Suspended Students
EC 49079 (a) A school district shall inform the teacher of each pupil who
has engaged in, or is reasonably suspected to have engaged in, any of the
acts described in any of the subdivisions, except subdivision (h), of Section
48900.

The district shall provide the information to the teacher based upon
records that the district maintains in its ordinary course of business, or
receives from a law enforcement agency, regarding a pupil described in this
section.
This information shall be identified from the previous three school years and
is provided through alerts in the Student Information System which is
accessed by teachers.
Student Services
Office: (760) 416-6030
Fax: (760) 416-6038
57
INTERVENTIONS
Counseling Services
COUNSELING: Confidential, easy access to professionally trained counselors are available
in Palm Springs, Desert Hot Springs, Indio and Palm Desert.
NON-PROFIT COUNSELING SERVICE AGENCIES
Jewish Family Services in Palm Springs
(760) 325-4088
Family Services of the Desert in Indio
(760) 347-2398
Caritas Family Counseling
in Desert Hot Springs
(760) 288-3313
All-Desert Wellness Centers in
Palm Desert
(760) 797-5151
Note: Counseling cost may very, please call agency for information.
Student Services
Office: (760) 416-6030
Fax: (760) 416-6038
58
INTERVENTIONS
INSIGHT Programs
Students are referred to the District INSIGHT Program when he/she has violated Education Code 48900(c),
48900(d), or 48900(j) which are drug and alcohol, or paraphernalia related offenses and has been suspended
for 3-5 school days.
Students are referred to the District INSIGHT Plus-Program (Middle Schools only) when he/she has
violated Education Code 48900(c), 48900(d), or 48900(j) which are drug and alcohol, or paraphernalia related
offenses or has violated 48900(a-1) or 48900(a-2) which are offenses related to acts directly against another
person and has been suspended for 3-5 school days.
Referral Process
Student and parent are required to meet with a Student Assistance Program staff member for a family meeting
within 3-5 days period of suspension or parents may participate in the district’s Parent Support Group.
Student will be required to participate and complete the necessary counseling sessions of the program which
include education/awareness about the consequences of substance abuse and acquire skills to make positive
choices.
Please contact the Student Services Office
at (760) 416-6027
to schedule an appointment.
Office: (760) 416-6027
Fax: (760) 416-6038
59
INTERVENTIONS
Section 504
Students who are handicapped within the meaning of Section 504 of the Rehabilitation Act of
1973, must be identified, evaluated, and provided with the required appropriate education.
A student who is qualified for accommodations under Section 504 is a student who:



Has a physical or mental impairment that substantially limits one or more major
life activities, including learning
Has a record of such impairment or
Is regarded as having such an impairment
Students may be handicapped under Section 504 of this policy even though they do not
require services pursuant to the California Special Education Programs Act.
A copy of the current 504 Plan is to be sent to Jane Mills, Director of Student Services at
[email protected], please cc [email protected].
504 FORMS: Go to District WEB-SITE under “Student Services”

Staff Login (user name/password)

Select: “Students and Parents”

Select: “Student Support Services”

Scroll down to “Staff Information and Forms”

Select: “Forms to Establish a 504 Plan”
You may also access forms in the “P” Drive in the 504 folder.
Student Services
Office: (760) 416-6032
Fax: (760) 416-6038
Forms available at
60
INTERVENTIONS
Centralized programs are available in the Palm Springs Unified School District that support the
welfare of students and families.
Parent Support Meetings – Individual families may meet with a district team member to
develop a positive plan for their children’s success.
INSIGHT Program – An afterschool student support group for substance abuse issues.

Topics: Substance Abuse Awareness
Student Attendance Review Board (SARB) – Monitoring & supporting the attendance of
students in the district.
The Community Liaison Team – Members of this team work directly with parents to address
school attendance and provide resources to families that could aid in the success of students.
In-District Training (Support by request) – Peer Conflict Mediation, Tolerance and
Diversity, Support Group Facilitation, PLUS Program (peer leadership).
Prevention Specialists – Support given to middle schools and high schools on the work with
struggling students.

Deliver drug prevention curriculum at schools.
Office: (760) 416-6030
Fax: (760) 416-6038
61
INTERVENTIONS
Student Success Team (SST)
The purpose of the Student Success Team (SST) is to use a systematic
problem solving approach to assist students who are not progressing at a
satisfactory rate.
The SST is a regular education process team that approaches and clarifies
problems and concerns, develops strategies, mobilizes and coordinates
resources that provides for a system of accountability with measureable
outcomes.
These elements create the potential for improved student success.
Student Services
Office: (760) 416-6030
Fax: (760) 416-6038
Forms available on
the district “P” drive
62
PUPIL RECORDS
Cumulative Records
PSUSD Schools:
Student’s cumulative file shall be forwarded to requesting PSUSD school site. Records shall
be purged of non pertinent documents prior to sending. A notification shall be written in the
student’s cumulative file and in ‘Student Information System’ as to the leave date and where
records were sent.
RECORD REQUEST– Archived Records:
The “Record” department is not set up for record request from non-district personnel. School
Sites, switchboard and other departments that receive a request for archived records shall direct
student to correct school or take the requested information then forward the request to Records
Department. Once records are located the records shall be sent back to the school site/
department to contact requestor. (see attached form)
RECORD REQUEST BY– Parent/Guardian (student under 18):
A “Record Request Form” shall be completed with a copy of the photo I.D. of the person
making request.
RECORD REQUEST BY– Adult Student: (same as above-see note below)
Note: If a pupil has attained the age of 18 years or is attending an institution of postsecondary
education, the permission or consent required of, and the rights according to, the parents or
guardian of the pupil shall therefore only be required of, and according to the pupil (Ed Code
49061)
MANDATORY Permanent Pupil Records: Each school district shall maintain indefinitely
all mandatory permanent pupil records or an exact copy thereof for every pupil who was
enrolled in a school program within said district. The mandatory permanent pupil record or a
copy thereof shall be forwarded by the sending district upon request of the public or private
school in which the student has enrolled or intends to enroll.
MANDATORY Interim Pupil Records: Records which schools are required to compile and
maintain for stipulated periods of time and are then destroyed as per California statue or
regulation.
Mary Walsh
Records Technician
Office: (760) 416-8318
Forms available at
63
Records Department
150 District Center Drive
Phone (760) 322-4116 Fax: (760) 318-6260
Record Request
________________
__________________________
Date:
_________________
________________
Contact Name
Contact Number
School Site/Department
LAST NAME:
FIRST NAME
MIDDLE
INITIAL
SEX:
M/F
DOB
GRADUATED
Y/N
MAIDEN NAME / AKA: (If applicable)
LAST SCHOOL OF ATTENDANCE AT PSUSD
LAST YEAR OF ATTENDECE AT PSUSD
SPECIAL SERVICES RECEIVED: (If applicable)
(Psych Services / IEP / Home Study etc.)
TYPE OF RECORDS:
x Transcripts
x Sealed
Copy Needed
(Transcripts are official only if delivered in a sealed envelope, any official transcript that you open, becomes unofficial. Unofficial transcripts are not signed and
will be delivered to you unsealed.)
 Other Records
RECORDS FROM:
SEND RECORDS TO:
NAME:
NAME:
ADDRESS
ADDRESS
CITY
STATE
ZIP
CITY
STATE
ZIP
CONTACT PHONE:
CONTACT PHONE:
SIGNATURE OF FORMER STUDENT
Please provide Photo Identification with signature
SIGNATURE OF GUARDIAN (If applicable)
Please provide Photo Identification with signature
64
Cumulative Records
Requests & Transfers
(Quick Reference Procedures)
 PSUSD Schools
Student’s cumulative file shall be forwarded to requesting PSUSD school site. Records shall be purged of non
pertinent documents prior to sending. A notation shall be written in the student’s cumulative file and in Zangle
as to the leave date and where records were sent.
 Another District or School in California
Student’s cumulative file shall be sent to requesting district or school after creating a copy of all Mandatory
Permanent records which shall be retained at school site for retention period according to the school year
student left district. Records shall be purged of non pertinent documents prior to sending. A notation shall be
written in the student’s cumulative file and in Zangle as to the leave date and where records were sent.
 Private / Out of State District or School
Original student’s cumulative file shall be retained at school site for retention period according to the school
year student left district and only a copy of student’s cumulative file shall be sent to requesting school. Create
a copy of all Mandatory Permanent and Mandatory Interim records for requesting private / out of state district
or school. Records shall be purged of non pertinent documents. A notation shall be written in the student’s
cumulative file and in Zangle as to the leave date and where records were sent.
 Record Request - Parent / Guardian (student under 18)
A “Record Request Form” shall be completed with a copy of the photo I.D of the person making request.
(See attached)
 Record Request - Adult Student
A “Record Request Form” shall be completed with a copy of the photo I.D of the person making request.
(See attached)
NOTE: If a pupil has attained the age of 18 years or is attending an institution of postsecondary education, the
permission or consent required of, and the rights accorded to, the parents or guardian of the pupil shall
thereafter only be required of, and accorded to, the pupil. (Ed Code 49061)
 Record Request - Archived Records
The Record Department is not set up for record requests from non-district personnel. School Sites, Switchboard
and other departments that receive a request for archived records shall direct student to correct school or take
the requested information then forward the request to Records Department. Once records are located the
records shall be sent back to the school site / department to contact requestor.
Please have the student / guardian complete a “Record Request Form” with as much information as possible and
have them sign form. We will also need a copy of the students photo I.D. with this request. Important
information needed: Name records are listed under (AKA, legal, maiden etc.); Date of Birth; School / Year
last attended; Type of records being requested; Contact number; sending / pick-up information. This will help
assist in locating the records in a timely manner.
Should you have any questions regarding archived records, please contact Mary Walsh, Records Technician at
(760) 416-8318.
65
Cumulative Record
Request & Transfers
(Quick Reference for State Regulations)
 Transfer of Records (CA Administration Code 438):
(a) When a pupil transfers to another school district or to a private school, a copy of the pupil’s Mandatory Permanent Pupil Record
shall be transferred upon request from the other district or private school. The original or a copy must also be retained permanently
by the sending district. If the transfer is to another California public school, the pupil‘s entire Mandatory Interim Pupil Record shall
be forwarded. If the transfer is out of state or to a private school, the Mandatory Interim Pupil Record may be forwarded. Permitted
pupil records may be forwarded. All pupil records shall be updated prior to such transfer.
(b) If the pupil is a within-California transfer, the receiving school shall notify parents of the record transfer. If the student transfers
out of state, the sending district may notify the parents of the rights accorded them. The notification shall include a statement of the
parent's right to review, challenge, and receive a copy of the pupil record, if desired.
(c) Pupil records shall not be withheld from the requesting district because of any charges or fees owed by the pupil or his parent. This
provision applies to pupil in grades K-12 in both public and private schools.
 Varieties of Pupil Records (CA Administration Code 432):
(1) "Mandatory Permanent Pupil Records" are those records which the schools have been directed to compile by California statute
authorization or authorized administrative directive. Each school district shall maintain indefinitely all mandatory permanent pupil
records or an exact copy thereof for every pupil who was enrolled in a school program within said district. The mandatory permanent
pupil record or a copy thereof shall be forwarded by the sending district upon request of the public or private school in which the
student has enrolled or intends to enroll.
(2) "Mandatory Interim Pupil Records" are those records which schools are required to compile and maintain for stipulated periods of
time and are then destroyed as per California statute or regulation.
(3) "Permitted Records" are those pupil records which districts may maintain for appropriate educational purposes.
 Procedure for Access to Pupil Record (CA Administration Code 435):
(a) Authorized organizations, agencies, and persons from outside the school, to the chief school whose access requires the consent of
the parent or the adult pupil must submit their request to view the records, together with any required authorization administrator or
the custodian of records.
(b) The chief school administrator or the custodian of records or a certificated designee shall be responsible during the inspection for
interpretation of the records where necessary and for prevention of their alteration, damage, or loss. In every instance of inspection of
pupil records by persons who do not have assigned educational responsibility, an entry shall be made in the access log of said record,
indicating the name of the person(s) granted access, the reason access was granted, the time and circumstances of inspection, and the
records inspected.
 Retention and Destruction of Pupil Records (CA Administration Code 437):
(a) No additions except routine updating shall be made to the record after high school graduation or permanent departure without the
prior consent of the parent or adult pupil.
(b) Mandatory permanent pupil records shall be preserved in perpetuity by all California schools according to Chapter 2, Division 16,
Part I, of this title.
(c) Unless forwarded to another district, mandatory interim pupil records may be adjudged to be disposable when the student leaves
the district or when their usefulness ceases. Destruction shall be in accordance with Section 16027 of this title during the third school
year following such classification.
(d) Permitted pupil records may be destroyed when their usefulness ceases. They may be destroyed after six months following the
pupil's completion of or withdrawal from the educational program.
The method of destruction shall assure that records are not available to possible public inspection in the process of destruction.
66
 Definitions (Education Code 49061):
(a) "Parent" means a natural parent, an adopted parent, or legal guardian. If the parents are divorced or legally separated, only a
parent having legal custody of the pupil may challenge the content of a record pursuant to Section 49070, offer a written response to a
record pursuant to Section 49072, or consent to release records to others pursuant to Section 49075. Either parent may grant consent if
both parents have notified, in writing, the school or school district that an agreement has been made. If a pupil has attained the age of
18 years or is attending an institution of postsecondary education, the permission or consent required of, and the rights accorded to, the
parents or guardian of the pupil shall thereafter only be required of, and accorded to, the pupil.
(b) "Pupil record" means any item of information directly related to an identifiable pupil, other than directory information, which is
maintained by a school district or required to be maintained by an employee in the performance of his or her duties whether recorded
by handwriting, print, tapes, film, microfilm or other means. "Pupil record" does not include informal notes related to a pupil
compiled by a school officer or employee which remain in the sole possession of the maker and are not accessible or revealed to any
other person except a substitute. For purposes of this subdivision, "substitute" means a person who performs the duties of the
individual who made the notes on a temporary basis, and does not refer to a person who permanently succeeds the maker of the notes
in his or her position.
(c) "Directory information" means one or more of the following items: pupil's name, address, telephone number, date and place of
birth, major field of study, participation in officially recognized activities and sports, weight and height of members of athletic teams,
dates of attendance, degrees and awards received, and the most recent previous public or private school attended by the pupil.
(d) "School district" means any school district maintaining any of grades kindergarten through 12, any public school providing
instruction in any of grades kindergarten through 12, the office of the county superintendent of schools, or any special school operated
by the department.
(e) "Access" means a personal inspection and review of a record or an accurate copy of a record, or receipt of an accurate copy of a
record, an oral description or communication of a record or an accurate copy of a record, and a request to release a copy of any record.
(f) "County placing agency" means the county social service department or county probation department.
 Record Access Log (Education Code 49064):
A log or record shall be maintained for each pupil's record which lists all persons, agencies, or organizations requesting or receiving
information from the record and the legitimate interests therefore. Such listing need not include:
(a) Parents or pupils to whom access is granted pursuant to Section 49069 or paragraph (6) of subdivision (a) of Section 49076;
(b) Parties to whom directory information is released pursuant to Section 49073;
(c) Parties to whom written consent has been executed by the parent pursuant to Section 49075; or
(d) School officials or employees having a legitimate educational interest pursuant to paragraph (1) of subdivision (a) of Section
49076. The log or record shall be open to inspection only by a parent and the school official, or his designee, responsible for the
maintenance of pupil records, and to the Comptroller General of the United States, the Secretary of Health, Education, and Welfare,
and administrative head of an education agency as defined in Public Law 93-380, and state educational authorities as a means of
auditing the operation of the system.
 Reasonable Charge (Education Code 49065):
Any school district may make a reasonable charge in an amount not to exceed the actual cost of furnishing copies of any pupil record;
provided, however, that no charge shall be made for furnishing (1) up to two transcripts of former pupils' records or (2) up to two
verifications of various records of former pupils. No charge may be made to search for or to retrieve any pupil record.
 Transfer of Records (Education Code 490685):
Whenever a pupil transfers from one school district to another or to a private school, or transfers from a private school to a school
district within the state, the pupil's permanent record or a copy thereof shall be transferred by the former district or private school upon
a request from the district or private school where the pupil intends to enroll. Any school district requesting such a transfer of a record
shall notify the parent of his right to receive a copy of the record and a right to a hearing to challenge the content of the record. The
State Board of Education is hereby authorized to adopt rules and regulations concerning the transfer of records.
 Access to Pupil Records (Education Code 49075 (a):
A school district may permit access to pupil records to any person for whom a parent of the pupil has executed written consent
specifying the records to be released and identifying the party or class of parties to whom the records may be released. The recipient
must be notified that the transmission of the information to others without the written consent of the parent is prohibited. The consent
notice shall be permanently kept with the record file.
 Please Remember:





Record Request / Transfers need to be log in record
All school sites are to forward their own sites records
Original or Copy must be retained permanently (Retained for PSUSD records).
Records shall be purged of non pertinent documents prior to sending records.
Adult Students over 18 can only authorize release of records (this includes Parents).
67
PUPIL RECORDS
Subpoenas
A “Subpoena” for student records is to be forwarded to the Director of Student Services for
review and response.
A “Subpoena” for employee records should be forwarded to the Assistant Superintendent of
Human Resources.
Student Services
Office: (760) 416-6030
Fax: (760) 416-6038
68
SAFE SCHOOLS
You and your staff are mandated reporters:
You shall report the known or suspected instances of child abuse to a
child protective agency immediately or as soon as practicably possible by
telephone and shall prepare and send a written report thereof within 36
hours of receiving the information concerning the incident.
LOCAL REPORTING
Child Protective Services
Desert Hot Springs Police Dept
Palm Springs Police Department
Cathedral City Police Department
Riverside County Sheriff Dept
Riverside County CPS (mandated)
773-6700 / 863-7210 (General #)
329-2904
323-8116
770-3000
1 (800) 950-2444
1 (877) 922-4453
1-800 442-4918
CPS forms and information can be accessed through this website:
 dpss.co.riverside.ca.us/childprotectiveservices.aspx
or through the Riverside County CPS Website:
 www.countyofriverside.us
Mandated reports to be sent:
Child Protective Services
23119 Cottonwood Avenue
Building ‘B’, 2nd Floor
Moreno Valley, CA 92553
69
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Child Protective Services (CPS) Procedural Protocol and Guidelines
for Accessing Children and Records at School Sites
RIVERSIDE COUNTY
OFFICE OF EDUCATION
Introduction
Whenever a representative of a government agency investigating suspected child abuse or
neglect (Law Enforcement) or the State Department of Social Services (Riverside County
Department of Public Social Services (DPSS)/ Child Protective Services) deems it necessary, a
suspected victim of child abuse or neglect may be interviewed during school hours, on school
premises, concerning a report of suspected child abuse or neglect that occurred within the
child's home. or out-of-home care facility.(Penal Code 11174.3)
A CPS representative may also need to access educational records of a court dependent child
for the purpose of obtaining educational information necessary to complete the child's Health
and Education Passport.
This protocol describes the basic procedural guidelines by which a law enforcement officer or
DPSS/CPS representative may access a child at a school site and/or how a CPS representative
may retrieve a court dependent child's school record.
Parties
This procedural protocol and operational agreement is between the following parties:
• The Riverside County Office of Education
• The Riverside County Department of Public Social Services
• The School Districts of Riverside County
• Law Enforcement agencies within Riverside County
Interviewing Children on School Premises
Penal codes 11174.3 and 11167.5 specify procedures and policy for interviewing children who
are suspected victims of child abuse, on school premises, concerning a report of suspected
child abuse, which occurred in the child's home or in an out-of-home care facility. The child
shall be afforded the option of being interviewed in private or selecting any adult who is a
member of the staff of the school, including any certificated or classified employee or volunteer
aide, to be present at the interview. The law enforcement officer or CPS representative shall
inform the child of that right prior to the interview.
The purpose of the staff person's presence at the interview is to lend support to the child and
enable him or her to be as comfortable as possible during the interview process. The staff
member selected by the child may choose to decline to participate. The staff member shall not
participate in the interview or discuss any ~acts or circumstances of the case with the child and
is subject to all confidentiality requirements.
A representative of the school shall inform a member of the staff so selected by a child of the
requirements of this section prior to the interview.
1126/05
71
Release of a Student into Custody
If a child is released from school as a victim of suspected child abuse into the custody of a
peace officer or CPS representative, the school shall provide the peace officer/CPS
representative with the address and telephone number of the minor's parent or guardian. The
agency will notify the parent or guardian that the minor is in custody. If the parent/guardian
inquires at the school before being notified about the student's location, the school shall refer
the parent/guardian to the agency that took the child into protective custody. (Education Code
48906) No' additional information should be given.
School Identification of DPSS Worker
School officials must verify and document the identity of a Child Protective Service's
representative who is requesting to see a child at the school site and/or before releasing a child
from the school site to the representative.
DPSS representatives will have an identification badge. There are two different badges that are
acceptable forms of identification in Riverside County. One is a white badge' with the DPSS
logo in blue in the upper left corner, the badge number is in red on the right side, and the
representatives color picture is on the lower left side. On the back of this badge will be
"Mandatory Responder Information". Most CPS workers have an orange laminated badge with
their color photograph and signature. Either of these badges is acceptable. Most
representatives will carry business cards, but all will have badges.
School Site Procedures
The CPS representative will state the reason for the visit/release from school, and/or the reason .
to view the child's school records to the school official, while maintaining appropriate
confidentiality. The reason does not need to be so specific as to divulge confidential
information; for example, the representative may state that they are there to follow-up or as part
of an investigation.
The school official shall ensure the child's confidentiality by having the representative sign their
name on a "CONFIDENTIAL LOG"' provided by the school official. This log. is to be maintained
in a secure area of the school office. The CPS representative shall not sign the normal school
sign in/sign out sheet as this is accessible to the public and would violate confidentiality.
Upon signing the CONFIDENTIAL LOG, the CPS representative shall wait for specific
instructions from the school official as to:
• Whether or not the child is in school, and/or
• Where to meet with the child at the school site
When a CPS representative needs to review or obtain copies of recent report cards, progress
reports or attendance records these should be copied and provided in a timely manner. If
records are needed, prior notification by the CPS representative will expedite the process.
When a CPS representative is given permission to view a student's Cumulative File, the CPS
representation will be required to sign a log indicating they have reviewed the cumulative file.
1/26/05
72
Specific instructions will be given regarding viewing and copying these records. (Education
Code 49064)
The CPS representative may need to know that obtaining/accessing records at the school site
could take up to five (5) business days from the initial request date. Schools will make· every
attempt to deliver records in a timely manner. (Education Code 49069)
Confidentiality for Mandated Reporters
The identity of mandated reporters is protected under Penal Code 11167 and shall be
confidential and disclosed only among agencies receiving or investigating mandated reports.
The parent, guardian or out-of-home care provider shall not be informed as to who made a
report.
Response to Mandated Reporters
At the conclusion of an investigation, the mandated school reporter should receive, in writing,
the disposition of the case. No specific details will be provided to ensure the child's
confidentiality .
Unacceptable Practices by School Site Personnel
The following is a list of practices, which is strongly discouraged; School staff shall NOT:





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
Request to see a CPS representative's driver's license. (Their employee badge is
sufficient for identification purposes.)
Photocopy the CPS representative's identification badge. (They will sign a confidential
log indicating their name, agency and the student they are working with.)
Place the CPS worker's identification (business card) in the students file.
(This is confidential information and should not be placed in the student's cumulative
file.)
Use a student to retrieve a child for the purposes of a visit with a CPS worker.
(Confidentiality must be maintained.)
Notify parent/guardians of a CPS representative's visit at the school site.
Do not accept an ihitial request for records by fax or other electronic means. (Initial
requests should be made in person so identification can be checked.)
1/26/05
73
SAFE SCHOOLS
Custody Issues
When you have a question about legal documents relating to child custody or a restraining
order, please call the Student Service office at (760) 416-6032 for clarification as to the correct
process.
Student Services
Office: (760) 416-6030
Fax: (760) 416-6038
74
SAFE SCHOOLS
Dangerous Student Notification
Student Services office receives information from the Juvenile Court regarding students
adjudicated for certain dangerous crimes.
Principals receive notification regarding these students and are required to inform teachers who
have these students in their classes.
These forms are to be kept in a separate “confidential” file.
Student Services
Office: (760) 416-6030
Fax: (760) 416-6038
75
PALM SPRINGS UNIFIED SCHOOL
DISTRICT
(760) 416-6000
FAX (760) 416-6015
CHRISTINE J. ANDERSON, Ed.D., Superintendent of Schools
BOARD OF EDUCATION: RICHARD R. CLAPP, President – KAREN CORNETT, Clerk
JUSTIN BLAKE, Member –GARY JEANDRON, Member – SHARI STEWART, Member
To:
Date:
From:
Jane E. Mills, Director, Student Services
Subject:
Notification regarding students who have been found by a court of competent
jurisdiction to have committed any felony or any misdemeanor involving
curfew, gambling, alcohol, drugs, tobacco products, carrying of weapons, a
sex offense listed in section 290 of the Penal Code, assault or battery,
larceny, vandalism, or graffiti.
Procedure:
In accordance with Welfare and Institutions code 827 (b) the principal shall
expeditiously disseminate the information provided to those counselors
directly supervising or reporting on the behavior or progress of the minor. In
addition, the principal may disseminate the information to any teacher or
administrator directly supervising or reporting on the behavior or progress of
the minor whom the principal believes needs the information to work with the
pupil in an appropriate fashion, to avoid being needlessly vulnerable or to
protect other persons from needless vulnerability. Any individual receiving
this information shall keep it confidential and not further disseminate it to any
individual or group. This information is to be kept in a separate confidential
file at the school of attendance and shall be transferred to the minor’s
subsequent schools of attendance and maintained until the minor graduates
from high school, is released from juvenile court jurisdiction, or reaches the
age of 18, whichever occurs first. After that time this confidential record shall
be destroyed.
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Counselor/Teacher/Administrator:
This memorandum is given to you in accordance with Welfare and Institutions code 827.
Records received from the court system indicate that the listed student has committed the
felony or misdemeanor listed below. You are statutorily authorized to receive this information;
however, the information is for your exclusive use only and is confidential. You may not
disseminate or disclose this information or the student’s identity to any other person including,
but not limited to, members of the community, other students, other faculty members, or any
other district employee. Disclosure of this information to any other person may subject you to
civil liability and disciplinary action.
Student Name:
The Court Ordered Disposition of Minor’s Case is as follows:
I acknowledge that I have reviewed this memorandum and understand the contents herein. I
further understand that the information is confidential and that I am not permitted to disclose
this information to any other person including, but not limited to, community members, other
students, other faculty members, or other district employees I understand that this
76
SAFE SCHOOLS
Emergency Management Plan
Emergency Management Plan includes:
Mitigation:
Reducing exposure and risks to hazards
Preparedness:
Planning, training, drills
Response:
Specific incident guidance
Recovery:
Psychological Recovery Guidance
Site Management Recovery Guidance
Refer to Palm Springs Unified School District “Emergency Management Plan Manual”
Darryl Scott, Manager
Security & Disaster Preparedness
Office: (760) 416-6120
Fax: (760) 416-6038
77

Student Services Handbook - Palm Springs Unified School

Transcription

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