affidavit of colorado residency: two pages: completely ... calvert... · affidavit of colorado...
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Enrollment Packet #2
Please ensure that the following items are scanned and emailed directly to our office at:
[email protected]. Keep in mind these are school-based and CDE requirements for
online schools and programs. They will serve as your final confirmation that it is your intent to enroll
your child at Academy Calvert K-8 Online School for the 2015/16 school year. Upon receipt of these
forms, we will order your child’s curriculum and have it sent directly to the address we have on file.
Please do not sign or date these documents prior to July 1, 2015.
If you have any questions, please do not hesitate to call us at: 719-258-1550
Checklist
1. Enrollment Information form: One page requiring a parent signature and date
2. Agreement of Exclusive Enrollment: One page requiring a parent signature and date
3. Academy Calvert Agreements: One page requiring student name, a parent signature and
date.
4. Affidavit of Colorado Residency: Two pages: completely fill out with the student’s PHYSICAL
address, a parent signature and date. No item on this form may be left blank.
5. ASD20 Appropriate Use of Technology for Students: Four pages requiring student and
parent signature and date.
Please keep your original copies. As soon as Academy Calvert K-8 Online School has a physical address
where we can reliably receive your mail, we will ask you to mail your originals to the school. We
appreciate your patience during this transition.
Warm Regards, Elizabeth Davis Principal
Academy Calvert Student Enrollment Information 2015-2016Instructions
1. Students not enrolled at any D20 school must begin the enrollment process for Academy Calvert in D20 by going tohttp://www.asd20.org/departments/ls/cr/Pages/Enroll.aspx, selecting New Student Registration, and then contacting Central Registry via email at [email protected].
2. Read the online school handbook at http://www.asd20.org/schools/aconline/Pages/default.aspx.
3. Complete all pages of this enrollment confirmation. Email forms to [email protected].
Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th
Final grade placement will be determined by the enrollment team, following completion of the placement test. Please note, your child may be placed in different grades for core and math.
Last Name ________________________________ First Name _____________________________________
Middle Name ______________________________ Birthdate ______________________________________
Address __________________________________ City, Zip ______________________________________
Parent/Guardian Name(s) _______________________________________________________________________
Home Phone __________________ Cell Phone ___________________ Work Phone _____________________
Email(s) ______________________________________________________________________________________
Last school attended ________________________________ Grade ___________________________
Last school address ____________________________________________________________________________
Last school phone/fax ______________________________ Email _____________________________________
Student/Family Information Date
Please print or complete this form electronically. The information below should match the legal information as displayed
on all other student forms.
Academy Calvert Grade Level
Student Signature (if above grade 4) Parent Signature
It is my intent to enroll my student at Academy Calvert K-8 Online School for the 2015-2016 academic year.
Date signed
Agreement of Exclusive Enrollment
Academy Calvert K-8 Online School is a public school receiving public funding. No child in Colorado can be enrolled simultaneously in more than one public program. For this reason, we require that you complete all required withdrawal paperwork from your child’s previous school upon enrollment at Academy Calvert K-8 Online School.
Your child may not be enrolled in any of these types of public programs:
Public virtual program.
Traditional brick and mortar public program.
Any publicly funded part‐time home school enrichment program which is offered by manypublic and charter schools.
Any publicly funded elective or ‘specials’ classes offered by another charter or public school.
Any sports programs offered by or through another charter or public school.
IF THE OTHER PROGRAM is funded through local, state or federal tax dollars, please do not enroll your child. If you have any questions regarding this policy, please contact our office prior to completing your enrollment.
This item is essential as any duplication of programs for a child will be identified by the Department of Education. If there is a discrepancy, we may ask you to withdraw your student from Academy Calvert K-8 Online School in order to eliminate the discrepancy. At that time, all school materials and computers must be returned to Academy Calvert K-8 Online School.
By signing this document, you agree that it is your intention to only enroll your child in Academy Calvert K-8 Online School and that you will not enroll your child in any other public program.
_______________________________________ ___________________________ Parent Signature Date
_______________________________
_______________________________
Names of Enrolled Student(s) in 2015‐2016
______________________________________
______________________________________
______________________________________ _______________________________
Academy Calvert K-8 Online School Agreements
By initialing next to each item below, you indicate that you have read them and are willing and able to support and follow the expectations of Academy Calvert.
Student Parent 1.
We have read and agree to follow the procedures andexpectations detailed in the Academy Calverthandbook.
2. We understand that coursework is delivered online andis best accessed by a newer computer capable ofplaying sound and video, recording sound, and isconnected to the Internet with a high-speed connection.
3. We understand that online students need to commit tofull participation in the online program, includingregular attendance and thorough completion of thecourse work.
4. We understand that enrollment means my student(s) isa public school student and is/are not considered ahomeschooler. We may not enroll in any other publicallyfunded program or take classes at another school.
5. We understand that homework is to be completed byassigned deadlines. If work is going to be late, it is theresponsibility of the student to contact the instructor.
6. For all students enrolled, we understand that onlinestudents are required to log on and be in “attendance”on October 1 in addition to regular course attendance asdirected.
7. We understand that email is one of the primarycommunication tools in online learning and should bechecked regularly through the week.
8. We understand that most digital communications maybe kept and archived and that these communicationsoften support and sometimes function as attendancerecords in courses.
9. We understand that inappropriate onlinecommunications or inappropriate use of online toolsmay lead to disciplinary action. Online bullying,harassment, and/or creating content as another personis subject to appropriate consequences.
10. We understand that online students are subject to thedistrict’s discipline policies and procedures and thosepolicies in the school and district handbooks.
11. We understand that all students in grades K-8 are strongly encouraged to participate in district and state-mandated testing.
Student name: _____________________________
Academy Calvert K-8 Online School Agreements, page 2
By initialing next to each item below, you indicate that you have read them and are willing and able to support and follow the expectations of Academy Calvert.
Parent Student 12. We understand that student enrollment status will be
regularly reviewed and continued enrollment will bebased on evidence that the student is doing his/herbest.
13. We understand that Academy Calvert classes are notself-paced and have regular due dates and deadlines,requiring daily work.
14. We understand that students who struggle withassignment and homework completion in-building maynot be a good fit for online classes and will requireregular extra time and attention to coursework.
15. We understand that school sports, club athletics, andrelated activities can be used to count for workouts forPE classes and we will submit a PE grid/signature sheetas proof of participation.
16. We understand that reading proficiency is a strongindicator of potential success in online classes.
17. We understand that students who are not on grade-levelwill be expected to fully participate in appropriateinterventions. This may require extra weekly timecommitments.
18. We understand that Academy Calvert classes aretrimester-based courses and that Academy Calvertdoes not grant incomplete grades for courses; all workmust be completed by the end of term due dates.
Student name: _____________________________
_______________________________________Parent signature
________________Date signed
Online School or Program Written Statement or Affidavit of Colorado Residency
(Updated 2/17/15) Information: Pursuant to 1 CCR 301‐71, Section 8.06, Rules for the Administration, Certification and Oversight of Colorado Online Programs, an online school or program “must verify and document student residency in the State of Colorado upon enrollment and annually thereafter and retain a copy of the document or written statement offered as verification in the student’s mandatory permanent record. Colorado residency is determined by the student and Parent or legal guardian currently residing within the State of Colorado boundaries, except for students of military families.”
Reasonable evidenced of residency may be established by documentation including, but not limited to, any of the following: (1) property tax payment receipts, (2) rent payment receipts, (3) utility service payment receipts, (4) written “Statement of Residency” executed by the student’s parent/guardian, and/or (5) appropriate residency documentation for a member or dependent of a member of the United States Armed Services.
Written “Statement of Residency” Colorado school districts submitting students for funding during the Student October Count data submission, pursuant to the Rules for the Administration of the Public School Finance Act of 1994, will be subject to audit. As part of the audit process, online schools or programs must be prepared to provide evidence of Colorado residency for all students submitted for online funding. In the event the online school or program decides to accept a “Statement of Residency” or “Affidavit of State of Colorado Residency” as evidence of the student’s Colorado residency, the online school or program must ensure that such statement or affidavit contains the following information. Absence of any of the information listed below will result in funding adjustments during the pupil enrollment count compliance audit for the district submitting the student(s) for funding.
1. An indication as to the school year in which the statement or affidavit applies.
A new statement or affidavit must be completed annually.2. Name of the person completing the form, and the relationship of that person to the student(s) for whom
the form is being completed.
The statement or affidavit must be completed by a parent/ guardian OR
By the enrolled student ONLY if:o The student is 18 years or older as of the date the statement/affidavit was completed
(as evidenced by the date on statement or affidavit).o The student is without a parent/guardian AND is in a crisis housing situation as defined
by the McKinney‐Vento Act. More information on this Act can be found at:www.cde.state.co.us/dropoutprevention/homeless_index
3. Name of the online school or program.4. A list of all students for whom the statement or affidavit apply.
All students enrolled in an online school or program must have evidence of Colorado residency
In the event a student is NOT included on a statement or affidavit of Colorado residency, butbelongs to a household that does have a statement or affidavit of Colorado residency, thatresidency statement or affidavit will NOT be allowed for the omitted student(s). A newstatement or affidavit must be obtained for the omitted or excluded student(s).
5. A physical address for the student(s) listed on the statement or affidavit.
The physical address CANNOT be a post office box or general delivery box at a post office.
In the event a student does not have a physical address (such as incidences of homelessness orcrisis housing situations), the general physical location of residency should be included. Inaddition, the online program and or school MUST contact the district McKinney‐Vento liaison.Please note that incidences of homelessness or crisis housing situations do NOT preclude astudent from enrollment in an online school or program.
6. Signature of the person completing the statement or affidavit.7. The date in which the statement or affidavit was completed.
A new statement or affidavit must be completed annually.
A statement can be completed as early as the start of the enrollment period for the online schoolor program for the given school year.
A statement or affidavit must be dated by the pupil enrollment count day for the given schoolyear.
*An example of a written “Statement” or “Affidavit” of Residency containing the information noted abovefollows.
Affidavit of State of Colorado Residency
Pursuant to 1 CCR 301‐71, Rules for the Administration, Certification and Oversight of Colorado Online Programs, the Colorado State Board of Education must ensure that student residency is documented and verified, both upon initial enrollment and annually thereafter, for all students enrolled in online schools and/or programs. Colorado residency is determined by the student and Parent or legal guardian currently residing within the State of Colorado boundaries, except for students of military families that maintain Colorado as their state of legal residence for tax and voter registration purposes. Reasonable evidence of residency within the State of Colorado boundaries can be established by a written statement of residency pursuant to Section 8.06.4.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Please complete all required fields (*) in order to evidence Colorado residency for those students listed below for purposes of residency status for the Colorado Department of Education. Failure to complete all required fields (*) will result in an invalid/incomplete Affidavit.
*Name of Person Completing this Affidavit: _______________________________________________
*Relationship to student(s) listed below:__________ Parent __________ Legal Guardian __________ Self (student 18 years or older) __________ Self (student without a parent/guardian AND is in a crisis housing situation as
defined by the McKinney‐Vento Act)
*Name of Online School/Program: ______________________________________________________
*List all students for whom this affidavit applies:1. ___________________________________________________________________________2. ___________________________________________________________________________3. ___________________________________________________________________________4. ___________________________________________________________________________5. ___________________________________________________________________________6. ___________________________________________________________________________
(If additional students enroll after the completion of this affidavit, a new affidavit must be completed for those students not listed above).
*Physical address (cannot be a post office box or general delivery at a post office) for all students listedabove:
____________ _______________ (*Street) (Apartment #)
__ (*City) (County) (*Zip)
I do hereby swear and affirm, under penalty of perjury, that the child(ren) listed above and I are currently, and will continue to be, residents of the State of Colorado for the 2015/2016 school year.
*Signature: _____ *Date:
Policy
IJND E-2 Appropriate Use of Technology Uses for Students
General Information
The Internet and Academy School District 20 local area and wide area networks are available to students
through Academy School District 20 Information Technology (IT) Services, and are used to conduct
research, complete assignments, and communicate and collaborate with others in support of their education.
Information accessed using district equipment or network should reflect the educational mission and goals
of the district. The district supports the use of Internet and electronic communications to improve teaching and learning.
The Internet is a fluid environment which is constantly changing. The district will make every reasonable
effort to ensure that this educational resource is used appropriately and responsibly, and to comply with
CIPA (Children’s Internet Protection Act) and other applicable laws. Staff and students should work together to develop the necessary skills to be successful in the 21st Century.
Student Responsibility
Students are responsible for their own use of district computers and computer systems.
Exercise good judgment.
Do not reply to electronic communications from people you do not know.
Only communicate things electronically that you would say in person.
Accounts and Passwords
Do not use another person’s login or password, even if you have their permission.
Do not tell anyone your password, or allow another individual to use your password.
Do not leave a computer unattended while you are logged in.
If you change your password (middle and high school student only), make sure it is
secure (e.g. don’t write it on your planner).
Student Use and Privileges
The use of ASD20 property and IT Services is a privilege and not a right.
Inappropriate use or vandalism may result in disciplinary measures, including loss of
computer and network privileges, suspension, expulsion, or civil or criminal liability
under applicable laws.
An account may be closed at any time should inappropriate activity occur, or if directed
by school or district administration.
Each student shall comply with federal and state law, district policy and the schools’
code of conduct and the provisions of this acceptable use agreement.
Students should report any inappropriate content or contact, including harassment,
threats, or hate speech to a responsible adult.
No Expectation of Privacy
The district reserves the right to monitor activity on the district network.
All web email must be accessed "in the clear" (with no encryption) except for password
communications.
E-mail and other electronic messages sent or received over the district network andmay be subject to disclosure under the Colorado Open Records Act.
Prohibited Uses Include:
Using district IT Services to publish, access, download, store, review and/or distribute
any content (text, graphic, photo, audio) that contains material which is defamatory,
abusive, obscene, profane, threatening, or sexually explicit ;
Using district technology in any fashion that violates school code of conduct, federal law
(e.g. copyright violations), state law, or district policy;
Using or attempting to use an Internet proxy server (anonymizer) or proxy software;
Using district technology to send unsolicited bulk email;
Performing tests on the district network to identify security faults;
Configuring a computer as an ad hoc wireless access point while it is connected to the
district network in any district facility, or using a standalone device to achieve the same
end (such as a cellular access point);
Possessing or using software without appropriate registration and payment of fees to the
software owner;
Using encryption to cloak network traffic, data files, or email communications within the
district network;
Possessing or using malicious software, hacking software, proxy software, or devices
used for these purposes on district property, including but not limited to: keystroke
capturing software or devices, network discovery and monitoring software or devices,
password recovery software and devices, and software specifically designed to remove
the evidence of user activity from a computer;
Enabling the remote (Internet) access of any computer on the district network through
Internet third parties (gotomyPC., etc.); and Attempting to bypass the internet filter in any way.
Collaborative Technologies
The district supports the use of collaborative technologies such as blogs, wikis and podcasts for
educational purposes. Students are responsible for the content they publish. Personal information
(such as address, phone number, e-mail address, etc.) should never be published. Electronic
spaces are to be considered the same as classroom spaces, and communications conducted there are to be respectful at all times.
These technologies are considered an extension of the classroom and should be used to:
Communicate with other students, parents, community members, or staff members;
Convey information about educational programs; and
Share information electronically.
Any communications posted to these types of collaborative technologies are district communications, and subject to disclosure under the Colorado Open Records Act.
District Makes No Warranties
The district is not responsible for any damages resulting from loss of data, email routing failures, or
service interruptions. Students who use network services provided by the district understand that their
failure to abide by the standards outlined in this agreement could make them subject to disciplinary
action.
STUDENT ACKNOWLEDGEMENT REGARDING USE OF TECHNOLOGY
1. I agree to abide by all terms and conditions. I further understand that violation of these terms and
conditions may result in the loss of the privilege to use these educational tools, school disciplinary action
including suspension or expulsion, legal action, and/or restitution by the user for costs associated with any
damages caused by such violations. I provide my consent for ASD20 to monitor all computer related
activity for user input, content and routing information including, but not limited to; email, web traffic,
and files stored on ASD20 servers and computers.
_____________________ ___________________________ ________________
Student’s signature Printed Name Date (Not required if approved electronically)
2. As the parent or legal guardian of the above student, I have read and reviewed this agreement with my
student.
If the YES box below is checked, I, the parent or legal guardian of the above student, give my express
consent to his/her use these resources and agree to ensure that my child understands and abides by the
terms and conditions of the “Appropriate Use of Technology Resources for Students” statement. I provide
my consent for ASD20 to monitor all computer related activity for user input, content and routing
information including, but not limited to: e-mail, web traffic, and files stored on ASD20 servers and
computers.
If the NO box is checked, I understand that my child will not be able to use school district technology to
accomplish any of the tasks or activities outlined above in the “Proper and Acceptable Use of All
Technology Resources” section.
YES NO Allow your child to access the Internet from D20 schools using D20 computers
Additional Permissions
YES NO Allow D20 to post your child’s photo on district, school, or classroom web
pages.
YES NO Allow D20 to post your child’s name on district, school, or classroom web
pages.
YES NO Allow D20 to post your child’s work on district, school, or classroom web
pages.
YES NO Allow 20TV (ASD20’s student-run TV station) to film your child for
informational stories for their weekly broadcast (appears weekly on
Comcast cable channel 19,and is downloadable from the district website, as
well as iTunes).
YES NO Military Opt-Out
Colorado Legislature made a change to the laws regarding release of student
information to military recruiters. The change in the law and to district policy
requires that we notify students that their name, home phone number, and
mailing address WILL BE RELEASED TO MILITARY RECRUITERS, UNLESS THE
STUDENT SPECIFICALLY REQUESTS THAT THE SCHOOL DOES NOT RELEASE
THIS INFORMATION. If you wish to opt-out of this program, select Yes.
All students, regardless of age, must have this acknowledgement signed by a parent or guardian in order
to access technology resources at school.
________________________ ____________________________ ___________________
Parent/Guardian signature Printed Name Date