Approved Robert Redfern, President Kim Sullivan, vice President

CHALLENGE OF LIBRARY/MEDIA CENTER MATERIALS FORM 5.6F

Name _________________________________________________________________________

Date Submitted: Level One _____________Level Two ___________ Level Three ______________
Instructional material being contested: ______________________________________________________________________________

_______________________________________________________________________________

Reason(s) for contesting the material (be specific): _______________________________________________________________________________

_______________________________________________________________________________

What is your proposed resolution? _______________________________________________________________________________

Signature of receiving principal _____________________________________________________

Signature of curriculum coordinator _________________________________________________

Date Adopted: 08-18-08 Last Revised: 08-10-11

REQUEST FOR RECONSIDERATION OF LIBRARY/MEDIA CENTER MATERIALS 5.7F
Name: ________________________________________________________________________
Date submitted: _______________________
Media Center material being contested: ______________________________________________________________________________________________________________________________________________________________
Reasons for contesting the material. (Be specific about why you believe the material does not meet the selection criteria listed in policy 5.7—Selection of Library/Media Center Materials):

What is your proposed resolution? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Signature of receiving principal________________________________________________________________________
Signature of Superintendent (if appealed) _______________________________________________________________________________
Date Adopted: 08-18-08

Last Revised: 08-10-11

HOME SCHOOLED STUDENTS' LETTER OF INTENT TO PARTICIPATE IN AN EXTRACURRICULAR ACTIVITY 5.19.2F
Student’s Name (Please Print) _____________________________________________________________________

Parent's Domicile Address
Street _______________________________________ Apartment ________________
City ____________________________________ State _____ Zip Code____________

_

Student's date of birth __/__/__ Last grade level the student completed ___________

Courses taken and grades earned in each course in the student's last year of school ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Extracurricular activity the student requests to participate in ______________________________________________________________________

Course(s) the student requests to take at the school ______________________________________________________________________

Proof of required immunizations/vaccinations _______

Proof of identity ________

Date Submitted __/__/__

Parent's Signature ______________________________________________________________________
SCHOOL CHOICE CAPACITY RESOLUTION 4.5F1

Whereas:

• 
  The Board of Directors of the Danville School District has approved by a vote of the Board, the following capacity resolution for school choice applicants for the school-year under the provisions of policy 4.5—SCHOOL CHOICE and applicable Arkansas law.
  
• 
  Applicants, whose applications meet the provisions of policy 4.5—SCHOOL CHOICE, will be sent a provisional acceptance notification letter which will give instructions on the necessary steps and timelines to enroll in the District. Provisional acceptance shall be determined prior to July 1 with a final decision to be made by August 1 based on the district's available capacity for each academic program, class, grade level, and individual school.
  
• 
  Applications that are not received on or before June 1, are to a student's resident district that has declared itself exempt due to an existing desegregation order, or, the acceptance of which would exceed the applicant's resident district's statutory limitation on student transfers out of its district will not be accepted.
  
• 
  The district reserves to itself the ability to determine, based on an examination of student records obtained from the prior district, and other information, whether any student would require a different class, course or courses, program of instruction, or special services than originally applied for If such an examination determines that capacity has been reached in the appropriate class, course or program of instruction, or that additional staff would have to be hired for the applicant, the District shall rescind the original provisional acceptance letter and deny the Choice transfer for that student.
  
• 
  The district reserves to itself the ability to decline to accept under school choice any student whose acceptance would require the district to add additional staff, for any reason.
  

THEREFORE, let it be resolved that these shall constitute the School Choice openings at the beginning of the School Choice enrollment period for the school-year _.

Board President Board Secretary

Date Date

SCHOOL CHOICE PROVISIONAL ACCEPTANCE LETTER 4.5F2
Dear Parent's name,
The application you submitted for student's name has been provisionally accepted. While the school's name looks forward to welcoming student's name as a student, to further the application process and to better assist the district in determining the proper placement of student's name, please submit the information listed below to district or school's address by enter date. Failure to submit the information requested by the date specified shall void and nullify this letter's provisional acceptance. In addition to the information you submit, records may be requested from the student's current district/school, and final acceptance may depend on the content of those records as to appropriate grade placement, program placement or services required. A student who has not previously attended an Arkansas public school or did not attend an Arkansas public school in the previous academic year may be evaluated by the district prior to final acceptance, and the results of that evaluation could impact final acceptance.

1. 
   For students applying to enroll in first grade or higher: a copy of the student's transcript from the last school where the student is currently enrolled. The student’s permanent record, including the original transcript, will be requested from the school immediately following the student’s actual enrollment in our district.
   
2. 
   Proof of the student's age; This can be a 1) birth certificate; 2) A statement by the local registrar or a county recorder certifying the child’s date of birth; 3) An attested baptismal certificate; 4) A passport; 5) An affidavit of the date and place of birth by the child’s parent or guardian; 6) United States military identification; or 7) Previous school records.
   
3. 
   The student’s health care needs at school.
   
4. 
   Student's name age appropriate immunization record or an exemption granted for the previous
   

school-year and a statement of whether or not the parent is intending to continue the exemption for the upcoming school year.

After reviewing the submitted documentation the District will determine if the applicant meets the District's capacity standards and notify you of its decision by insert date. Please note that the acceptance of an application can be reversed if it is determined that the application is in violation of student's name's resident district's limitation cap for available school choice transfers or if the resident district has reached its statutory cap for transfers out of its district.

Respectfully,


Insert name______
Insert position/title
SCHOOL CHOICE ACCEPTANCE LETTER 4.5F3
Dear Parent's name,

I am pleased to inform you that the application you submitted for student's name has been accepted pending enrollment of student's name by insert date, however, failure to enroll student's name by this date will render this offer of acceptance null and void.

I look forward to welcoming student's name as part of the school or District's name and/or mascot.
Once your child has enrolled in school with us this coming school-year, student's name will be eligible to continue enrollment in the district until completing high school or is beyond the legal age of enrollment provided the student meets the applicable statutory and District policy requirements all other District students must meet (with the exception of residency in the District) to continue District enrollment. This information is contained in the student handbook. You will be required to fill out a choice renewal form each year by insert date which can be picked up in our district's central office located at insert address.

Please Note: The "insert District's name" has no control over when a student's resident district might reach is statutory limit on allowable transfers out of its district. While we consider it unlikely, there is always the possibility that we could be forced to withdraw this acceptance if the resident district determines it reached its statutory cap for transfers out of its district prior to your student's application date to our District. You will be notified immediately should that rescission of acceptance be necessary. We apologize for this unavoidable uncertainty.

Respectfully,

Insert name

Insert position/title

SCHOOL CHOICE REJECTION LETTER 4.5F4

Dear Parent's name,

I am sorry, but the application you submitted for student's name has been rejected for the following reason(s).
Your child's resident district has declared itself exempt from the provisions of the School Choice Law due to it being under an enforceable desegregation order.
Your child's resident district has reached it limitation cap for allowable transfers and we cannot accept any additional school choice transfers from that district.
Your child does not meet the openings identified for the coming school-year identified in the Board of Directors Resolution adopted on insert date.
The specific reason for rejection is that acceptance would cause the district to have to add:
Staff
Teachers
classroom(s)
the insert the name of the program, class, grade level, or school building's capacity

As noted in your original application, you have ten (10) days from receipt of this notice in which to submit a written appeal of this decision to the State Board of Education.

Respectfully,

Insert name

Insert position/title
DANVILLE PUBLIC SCHOOLS DRUG RELEASE AND CONSENT FORM 4.24F
(This consent form must be signed each year.)
I, ___________________________________________ do hereby authorize the collection facility, physician or laboratory selected by the Danville School District to take urine specimens for laboratory analyses for the purpose of alcohol/drug testing, and I authorize the collection facility, physician, or laboratory to release the results of the test to the Danville School District. This release and consent form is subject to the terms and conditions of the alcohol/drug policy implemented by the Danville School District. A photocopy of this authorization can be used if the original is not available.
I understand that my refusal to authorize such examination will subject my child, ____________________ to immediate removal from all activities listed in the Chemical Screen Test Policy of this handbook.

I also am aware that once I sign this form it is valid for the entire school year even if I quit an activity or I am dismissed from an activity including athletics.

Student_____________________________________________________

Date_______________________________________________________

Grade______________________________________________________

Danville Public School

P.O. Box 939

Danville, Arkansas 72833

Dear Parent:

The following are areas of the handbook that require your signature. Please mark an (x) in each area indicating your response. Please sign this form in the area provided at the bottom and RETURN TO THE SCHOOL.
Handbook

_____YES _____ NO I have access to the Danville School Student Handbook. The handbook is on the school’s website and a hard copy will be available upon request. The Arkansas Department of Education requires us to keep proof of receipt of the student handbook in each student’s file.

Parent Involvement

_____YES _____ NO I have been made aware of the parental involvement Plan Link on the school web page through the student handbook.
PUBLICATION OF DIRECTORY INFORMATION (4.13F) :

I give permission to the school to release your students information to the following;

_____YES ______ NO TO MILITARY RECRUITERS

_____YES ______ NO TO POTENTIAL EMPLOYERS

_____YES ______ NO TO ALL PUBLIC AND SCHOOL SOURCES (EXAMPLE: PUBLIC NEWSPAPERS AND SCHOOL PUBLICATIONS)

_____YES ______ NO I AGREE TO THE TERMS AND CONDITIONS OF THE STUDENT INTERNET USE AGREEMENT (4.29-1)

Persmission
_____YES _____ NO I GIVE MY CHILD PERMISSION TO PARTICIPATE IN SCHOOL DAY FIELD TRIPS SPONSORED BY DANVILLE PUBLIC SCHOOL, WITHIN THE STATE
_____YES _____ NO I GRANT PERMISSION FOR MY CHILD TO PARTICIPATE IN PHYSICAL EXAMINATIONS OR SCREENINGS
_____ YES _____ NO I GIVE PERMISSION FOR MY CHILD TO PARTICIPATE IN PHOTOGRAPHS AND VIDEOS INCLUDING BUT NOT LIMITED TO THE DPS YEARBOOK, DANVILLE SCHOOL FACEBOOK PAGE, THE DANVILLE SCHOOL WEBSITE. (5.20)

______YES _____ NO I HEREBY GRANT MY PERMISSION FOR THE STUDENT NAMED BELOW TO PARTICIPATE IN SURVEYS, ANALYSIS, OR EVALUATIONS GIVEN AT THE SCHOOL. (5.24)
Student’s Name Grade
Student’s Signature
Parent’s Signature