Student and Parent Handbook 2014-2015
Vision The Bio-Med Science Academy is the pioneer and national model for graduating high caliber students having critical thinking skills, experienced in a rigorous education in STEM+M disciplines, made possible through integrated curricula partnerships and collaboration with Northeast Ohio Medical University, government, businesses, private industry, local public and private schools and regional colleges and universities.
Mission Bio-Med Science Academy prepares students to succeed as professionals in the high demand fields of science, technology, engineering, mathematics and medicine. The Academy’s Innovation in curricula and curricula delivery cultivates academic excellence while nurturing critical thinking skills, student collaboration, inventiveness and sense of community. Through STEM+M based education, the Academy delivers a unique learning experience to high school students from rural communities who want to gain an edge in preparing to become STEM+M professionals serving in rural areas.
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Table of Contents
Vision .........................................................................................................................................................................2 Mission ......................................................................................................................................................................2 Calling off from School ..............................................................................................................................................7 Early Dismissal from School.......................................................................................................................................7 Dress and Grooming ..................................................................................................................................................8 Visitors, Volunteers, and Guests .............................................................................................................................12 Student Attendance.....................................................................................................................................................13 General Policy..........................................................................................................................................................13 Calling off from School ............................................................................................................................................13 Excused Absences ...................................................................................................................................................13 Early Dismissal from School.....................................................................................................................................14 Disciplinary Action for Unexcused Tardiness or Absence .......................................................................................14 Truancy ....................................................................................................................................................................14 General Student Policies ..............................................................................................................................................15 Books and Other Property of the School.................................................................................................................15 Lockers ....................................................................................................................................................................15 Student IDs ..............................................................................................................................................................15 Lost and Found ........................................................................................................................................................15 Student Expression ..................................................................................................................................................15 Dress and Grooming ................................................................................................................................................15 Medications at school .............................................................................................................................................15 Electronic Communication Devices .........................................................................................................................16 Technology and Internet Acceptable Use ...............................................................................................................17 Mastery Learning and Grading ................................................................................................................................19 Graduation Requirements .......................................................................................................................................20 Student Code of Conduct ........................................................................................................................................20 Insubordination .......................................................................................................................................................21 Sexual and Other Forms of Harassment..................................................................................................................21 Anti-Harassment, Intimidation and Bullying ...........................................................................................................22 Anti-Hazing ..............................................................................................................................................................23 Gang Activity ...........................................................................................................................................................24 Disorder and Demonstration...................................................................................................................................24 Drug Prevention ......................................................................................................................................................24 Search and Seizure ..................................................................................................................................................25 Expulsion and Suspension Policies ..........................................................................................................................28
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Contact Information School Office – 330.325.6186 Website – www.biomedscienceacademy.org Chief Administrative Officer:
Staff Emails
Stephanie Lammlein -
[email protected] Dean of Students: Scott Musser –
[email protected] Office Manager: Cortney Porter -
[email protected] Office Aides: Jenice Eldreth –
[email protected] Jeri Englehart –
[email protected] School Counselor: Stephanie Hammond -
[email protected] Art: Keagan O’Mara –
[email protected] Foreign Language: Sarah Siao –
[email protected] Sue Schwartzhoff -
[email protected] Intervention Specialists: Lydia Friedman –
[email protected] Ashley Heavilin –
[email protected] Intervention Aide: Tersina Sweitzer –
[email protected] Language Arts: Megan Connor -
[email protected] Candace Hisey –
[email protected] Brian McDonald -
[email protected]
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Mathematics: Lisa Berry –
[email protected] Christine Ward –cward@@biomedscienceacademy.org Sandra Wilder -
[email protected] Media Specialists: Annette Lang -
[email protected] Science: Carl Harrison –
[email protected] Matt MacKeown -
[email protected] Marissa Manocchio –
[email protected] Ravin Pandey –
[email protected] Ryan Willard –
[email protected] Social Studies: Karl Hegyi –
[email protected] Lindsey McLaughlin -
[email protected] Max Monegan -
[email protected]
Building Hours Operation times- 7:30 a.m. – 4:30 p.m. Class Hours – 8:30 a.m. – 3:15 p.m. Drop-Off – 8:00 a.m. – 8:30 a.m. Pick –Up – 3:15 p.m. – 4:00 p.m.
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Calendar 2014-2015
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first day of school
Accelerated Terms
Last day of school
no school staff and students
187 days
staff professional development - no school for students may be used for contingency days
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Parent’s Quick Guide Calling off from School A legal guardian must call the school (330.325.6186) to notify that his/her child or children will be absent. This phone call should take place no later than 9:30 a.m. If a legal guardian fails to call the school by 9:30a.m., school personnel will call and/or email the legal guardian to inform him/her of the student's absence. In those cases where telephone communication could not be made, school personnel will initiate a written communication to the home of the legal guardian the day of the student's absence.
Early Dismissal from School Any student who must leave school prior to the 3:15 p.m. dismissal must bring in a written request on the day of the early dismissal. This request should state the reason, time, and a phone number of a legal guardian.
Early Dismissal to Participate in Extracurricular Activities at a Student’s District of Residence
Any student that has attained a grade of “Proficient” or higher in at least 70% of their graded competencies is eligible for early dismissal to participate in an extracurricular activity at their district of residence. This justifiable reason for early dismissal may be utilized by the student no more than twice per academic term and once during academic accelerated term.
Students and legal guardians requesting early dismissal under this provision must complete the early dismissal for extracurricular event form and submit the form to the Chief Administrative Officer no later than two school days prior to the date of early dismissal. Students that have not attained a grade of “Proficient” or higher in at least 70% of their graded competencies may not be dismissed early for the purposes of participating in an extracurricular activity at their district of residence.
School Cancellation
If the school must be closed due to inclement weather or other conditions, students and legal guardians will be notified by the emergency notification system (text, call, and/or email). The cancellation will also appear on TV channels 3, 5, 8 and 19. Due to the unique nature of the Academy’s student body, if a student is unable to attend due to local weather conditions and their school district of residence is closed they will be expected to connect to the school electronically to complete assignments and obtain credit for the school day. At the discretion of the Chief Administrative Officer, the Academy may hold a “Digital Day” when the Academy is closed due to weather or other conditions. These days WILL count as an actual in-session school day and students are expected to complete the tasks assigned by designated times and participate in the learning of that day. Failure to do so will result in an unexcused absence. On digital days all students will receive an email by 9:00am that will
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include the specific instructions for that day. The Academy will utilized Adobe connect, Skype, SAIKI, and Google Docs to complete work.
Student Fees: Freshman - $185 (out of pocket ACT charges will be deducted from this amount once students have officially enrolled in the Academy.)
Sophomore - $185 Junior - $185
Dress and Grooming In general dress and grooming should be appropriate for the School. 1. Students must wear: •
Polo shirts with a collar. They can be long or short sleeved and must be of solid color. There may not be any writing or images on the shirts.
•
Trouser pants with no holes. They may be blue, black, or khaki in color. Pants must be worn at waist. No colored jeans.
•
Student ID on lanyard or on shirt collar at all times.
•
When cooler temperatures arise students may wear one of the following over their polo shirt: Bio-Med hoodie, cardigan style sweater or zipper sweatshirt of solid colors, polos must be worn under each of the above options.
2. Body jewelry, hair styles and color may not interrupt the educational process or pose a safety issue. Students will be in professional situations frequently and will need to represent themselves in such a manner or may lose the chance to participate in the opportunity. 3. Students will be required to wear school polo (lime green) on certain days. They will have timely notification.
Websites You Should Bookmark AIMS – https://aims.neomed.edu/portal/ Tracker – https://tracker.parloproject.org/ Bio-Med Science Academy –www. http://biomedscienceacademy.org/student-parent-portal/ Facebook - https://www.facebook.com/groups/biomedparents/
Annual ACT Testing The Academy will be handling the registration of all students for the ACT test on June 13th 2015. Forms will be sent home with all students on January 7th 2015. Forms must be completed and returned by January 18th 2015. Families are not responsible for registering or paying for their students.
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Volunteer Hours Volunteer hours are a requirement for graduation. The 130 hours must be completed by May 1st of the student’s graduating year. Hours completed must be documented and signed using the form included in this handbook. The form is also available on AIMS. Students may either use one form per organization and track all of their dates and hours together or they can turn in hours as they go. Students who do not complete the 130 hour requirement will not receive their high school diploma. Any student who plans to do volunteer work that conflicts with the normal school day must be mastered in all subjects and have the request to volunteer pre-approved by the Chief Administrative Officer. Failing to adhere to this procedure will result in an unexcused absence and no credit for the hours volunteered.
Graduation Requirements Bio-Med Science Academy - Graduation Requirements Academic Diploma with Honors for Classes 2011 and Beyond
Total Units Earned
Ohio Diploma Requirements
English
4
4
Mathematics
4
4
Science (minimum)
4
3
Engineering Social Studies *If a student needs 4
3
N/A
units to earn the honors diploma they MUST take social studies courses during accelerated term
3
3
4 units
Fine Arts Health Physical Education Electives
1 0.5 0.5
1
1 unit
0.5
Foreign Language
2
Subject Core Courses
4 units 4 units, including Algebra I, Geometry, Algebra II or the equivalent and another higher level course or a four-year sequence of courses that contain equivalent content 4 units, including physics and chemistry
0.5 5
Innovations and Entrepreneurship II Senior APEX Attributes Technology Accelerated Term courses (minimum)
3 0.25 1.5
Total Units
29.25
21
130
N/A
N/A 3 units (must include no less than 2 units for which credit is sought), i.e., 3 units of one language or 2 units each of two languages
0.5
2
Other Volunteer hours * Must have these hours completed and documented by MAY 1st of their graduating year
Grade Point Average ACT/SAT Score [excluding scores from the writing sections]* State Graduation Assessment
3.5 on a 4.0 scale 27 ACT / 1210 SAT Passing scores for the required state tests
Passing scores for the required state tests
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N/A
Dual Enrollment Dual enrollment classes are an opportunity for students to earn both high school and college credit at no charge without leaving the Academy’s campus. All dual enrollment classes are online and taught by a college professor with the Academy’s teacher as a support. Students participating in dual enrollment should budget on average an additional 5 hours per week per class they are enrolled in over and above their normal homework and study time. Should the student withdraw from the dual enrollment class outside of the specified withdrawal window, or should the student fail the class, then the student’s family is responsible for 100% of the tuition and fees for that course. Dates and deadlines are set by the partnering college or university and students are responsible for abiding by these deadlines.
Mastery Learning The Academy’s philosophical roots are grounded in the concept that all students will learn how to apply and implement their knowledge into their everyday lives and to solving current global issues. The Academy’s staff will work with the students to develop a level of thinking and learning that involves self-processing and a keen awareness of the knowledge they’ve gained. Students are expected to master the core curriculum concepts. If mastery of the curricular concept has not been achieved in the first attempt, students will then be given additional time and remediation if needed. However, students must follow the student success plan in order to earn the ability to improve their understanding of the concept. Students must master a course to progress onto the next course.
Student Academic Success Plan
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General Handbook Visitors, Volunteers, and Guests The Governing Authority welcomes and encourages visits to school by legal guardians and interested educators. But in order for the educational program to continue undisturbed when visitors are present and to prevent the intrusion of disruptive persons into the schools, it is necessary to invoke visitor controls. The Chief Administrative Officer has the authority to prohibit the entry of any person to the school or to expel any person when there is reason to believe the presence of such person would be detrimental to the good order of the school. If such an individual refuses to leave the school grounds or creates a disturbance, the Chief Administrative Officer is authorized to request from the local law enforcement agency whatever assistance is required to remove the individual. Rules regarding entry of persons other than students, staff, and faculty upon school grounds or premises shall be posted conspicuously at or near the entrance to such grounds or premises if there are no formal entrances, and at the main entrance to the school building. In addition, the rules shall be posted in a central location in each school and made available to students, upon request. In order to protect the educational programs of the schools from undue disturbance, the Chief Administrative Officer shall establish rules and procedures for visitors which shall include the following:
A. Persons wishing to visit the school are to make arrangements in advance through the school office. B. Every visitor to the school must register at the school office. C. No visitor may see a student in school unless it is with the specific approval of the Chief Administrative Officer. If
D. E. F.
G. H. I. J.
K.
an emergency situation requires that a student be called to the office to meet with a visitor, a member of the administrative staff must be present during the conference. A student is never to be permitted to leave the school with anyone who is not clearly identified as his/her legal guardian or an appropriately authorized person. Students may not bring guests to school unless permission to do so has been granted by the Chief Administrative Officer. No staff member is to transact business with a visitor who has not duly registered at the school office and received authorization to be present for the purpose of conducting business. Legal guardians, other than those who have been asked by a teacher to be in the classroom, who wish to observe learning activities taking place in their child's classroom are to confer, in advance, with the Chief Administrative Officer and the teacher and state the purpose of the visitation. It is important that each legal guardian understands that because classroom visitations can be distractive to the students, the legal guardians s are to be silent observers and are not to create any type of disturbance or disruption to the learning process. Copies of instructional materials being used by the students or teacher may not always be immediately available during the visitation. Use of audio or visual equipment to record classroom activities must be approved by the Chief Administrative Officer and the teacher. No visitor shall be allowed to videotape students in the classroom as it violates the privacy rights of students unrelated to the visitor. If the nature and instructional purpose of any activity calls for students to be segregated by gender, only visitors of the appropriate gender may observe those groups. If a legal guardian or other visitor wishes to tape record a conversation or meeting with a teacher or the Chief Administrative Officer, s/he should request permission from the teacher or Chief Administrative Officer. If the teacher or Chief Administrative Officer wishes to record a conversation with a legal guardian or other visitor, s/he is to inform that person that the conversation is being recorded before the conversation begins. Federal law allows a legal guardian to record an I.E.P. and, if the legal guardian does record, the school should record the conference also. Any comments or concerns are to be discussed with the teacher before or after the school day when students are not present. Visitors are to be encouraged to meet with the Chief Administrative Officer and teacher during non-instructional hours to discuss the observation and to obtain answers to their questions. If a legal guardian has a concern about what may be transpiring in his/her child's classroom, s/he should Governing Authority address the matter first with the teacher and, if not rectified, to then meet with the Chief Administrative Officer.
If a disabled person should visit a school and request accommodation and s/he has not submitted the Request for Accommodation, in advance, the Chief Administrative Officer should ask the person to allow the school adequate time to arrange for the accommodation, providing such accommodation is reasonable.
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The Chief Administrative Officer shall post in a conspicuous place at each entrance, the rules and procedures to be followed by visitors.
Student Attendance General Policy The educational program offered by this school is predicated upon the presence and punctuality of the student and requires continuity of instruction and classroom participation. In accordance with the laws of the State, Attendance shall be required of all students enrolled in the schools during the days and hours that the school is in session or during the attendance sessions to which s/he has been assigned. The regular contact of students with one another in the classroom and their participation in a well-planned instructional activity under the tutelage of a competent teacher are vital to this purpose. Attendance need not always be within the school facilities, but a student will be considered to be in attendance if present at any place where school is in session by authority of the Governing Authority. The Governing Authority shall consider each student assigned to a program of other guided learning experiences to be in regular attendance for the program provided that s/he reports to such staff member s/he is assigned for guidance at the place in which s/he is conducting study, and regularly demonstrates progress toward the objectives of the course of study. Repeated infractions of Governing Authority policy on attendance may result in suspension or expulsion. The Chief Administrative Officer or his/her designee may act as the school’s attendance officer or delegate that duty as permitted by law. The school’s attendance officer shall investigate possible school attendance violations, and is authorized under Ohio law, to serve warrants, to enter places where children of compulsory school age are employed, and to take such other actions as may be necessary to enforce the compulsory education laws. The Chief Administrative Officer shall: A.
establish proper procedures so the student and his/her legal guardians s are provided the opportunity to challenge the attendance record prior to notification and that such notification complies with R.C. 3321.13 (B)(2); establish a school session which is in conformity with the requirements of the rules of the State Governing Authority; govern the keeping of attendance records in accordance with the rules of the State Governing Authority; identify the habitual truant, investigate the cause(s) of his/her behavior, and consider modification of his/her educational program to meet particular needs and interests; refer for evaluation any student who, due to a specifically identifiable physical or mental impairment, exceeds or may exceed the school's limit on excused absence to determine eligibility either under the Individuals with Disabilities Education Act (IDEA) or Section 504 of the Rehabilitation Act of 1973, or other appropriate accommodation.
B. C. D. E.
Calling off from School 1.
See Parent’s Quick Guide
Excused Absences Absences due to the following will be excused: A. B. C. D. E. F.
Personal Physical Illness a. The Chief Administrative Officer may require a doctor's confirmation if s/he deems it advisable. Personal Mental Illness a. The Chief Administrative Officer may require a doctor's confirmation if s/he deems it advisable. Illness in the Family Necessitating the Presence of the Child a. The Chief Administrative Officer may require a doctor's confirmation and an explanation as to why the child's absence was necessary. Quarantine of the Home a. This is limited to the length of the quarantine as fixed by the proper health officials. Death in the Family a. This is limited to a period of three (3) days unless a reasonable cause may be shown for a longer absence. Necessary Work at Home Due to Absence or Incapacity of Legal Guardian
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a.
G. H.
I. J. K. L. M.
N. O. P. Q.
Any absence arising because of this condition shall only apply to a child over fourteen (14) years of age and shall not extend for a period longer than five (5) days and can be renewed for five (5) additional days. At no time, shall such excuse permit a student to be absent from school for a period of more than ten (10) consecutive days. b. At the discretion of the Chief Administrative Officer or his/her designee, a student may be excused for a longer period of time than ten (10) days if a child's legal guardian has recently died or become totally or partially incapacitated and there is no older brother or sister living in the home who is out of school. In such cases, the Chief Administrative Officer or his/her designee may request a certificate of a physician attesting to the physical condition of the legal guardian. Observation or Celebration of a Bona Fide Religious Holiday a. Any student shall be excused for the purpose of observing or celebrating a bona fide religious holiday consistent with his/her creed or belief. Absence During the School Day for Professional Appointments a. Legal guardians are to be encouraged to schedule medical, dental, legal, and other necessary appointments other than during the school day. Since this is not always possible, when a student is to be absent for part of the day: i. the student shall have a statement to that effect from his/her legal guardians; ii. the student shall report back to school immediately after his/her appointment if school is still in session. Emergency or Other Set of Circumstances a. The Chief Administrative Officer shall determine whether the reason for the absence constitutes good and sufficient cause. Service as Precinct Officer at a Primary, Special or General Election a. Students selected as precinct officials shall be excused from school on the day of an election at which the student serves as a precinct official. Court Subpoena Instruction at home from a person qualified to teach the branches of education in which instruction is required. If a student is absent from School for the sole purpose of traveling out of state to participate in a Schoolapproved enrichment activity or extra-curricular activity, the School shall count that absence as an excused absence, up to a maximum of 4 days per school year. a. The student must complete any classroom assignments he/she misses due to the absence. If the student will be absent for 4 or more consecutive school days, classroom teachers must accompany the student during the travel period to provide the student with instructional assistance in order to count the student as in attendance. Medically necessary leave for a pregnant student. The student was enrolled in another school district. The student was excused from attendance in accordance with R.C 3321.04. The student has received an age and schooling certificate.
Upon return to the school, the student must provide to the school a written statement from a legal guardian of the cause for absence, or the absence will be considered unexcused. The Chief Administrative Officer or his/her designee reserves the right to verify such statements and to investigate the cause of each individual absence.
Early Dismissal from School Any student who must leave the School prior to the 3:15 p.m. dismissal for appointments must bring in a written request on the day. This request should state the reason, time, and a phone number of a legal guardian. Disciplinary Action for Unexcused Tardiness or Absence Repeated unexcused absences/tardiness shall be grounds for disciplinary action in accordance with the school’s Policy. A student is tardy when a student is more than five minutes late for School or for a class. If a student misses more than half a class, the student will be marked absent for the class. Truancy A student is habitually truant if the student is absent without a legitimate excuse for five (5) or more consecutive academic days, for seven (7) or more academic days in one (1) month, or twelve (12) or more academic days in one (1) academic year. A student is chronically truant if the student is absent without a legitimate excuse for seven (7) or more consecutive School days, for ten (10) or more School days in one (1) month, or fifteen (15) or more School days in one (1) year. Legitimate excuses for the absence of a student otherwise habitually or chronically truant include but are not limited to: 1.
the student was enrolled in another school;
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2.
the student’s absence was excused in accordance with applicable law or policy; or,
3.
the student has received an age and schooling certificate.
If the student is habitually truant and the student’s legal guardians have failed to cause the student’s attendance, the Governing Authority authorizes the Chief Administrative Officer or his/her designee to inform the student and his/her legal guardian of the truancy record and the Governing Authority’s intent to notify the Judge of the Juvenile Court of the student’s excessive truancy.
General Student Policies Books and Other Property of the School The Governing Authority requires any book or material furnished to students for their temporary use be given good care and returned to the School once the item is no longer needed. If the item is abused beyond normal wear, a fine or replacement cost will be assessed against the student. Lockers Lockers are the property of the school and are therefore subject to random searches by authorized personnel at any time. Items may not be permanently affixed to the locker. See Search and Seizure Student IDs Students must have their school IDs visible at all times. The school will issue one ID to the student. A $15.00 replacement cost will apply to all lost, damaged, stolen, or otherwise unusable IDs. Students that do not wear their ID will be subject to disciplinary action per the Code of Conduct. Lost and Found Lost and found items will be held in the school’s main office. At the end of each trimester any unclaimed items will be donated or disposed of. Student Expression The school recognizes the right of students to express themselves. With the right of expression comes the responsibility to do it appropriately. Students may distribute or display, at appropriate times, non-sponsored, noncommercial written material and petitions: buttons, badges, or other insignia; clothing, insignia, and banners; and audio and video materials. All items must meet the following School guidelines: A.
B.
A material cannot be displayed if it: 1.
is obscene to minors, libelous, indecent, or vulgar,
2.
advertises any product or service not permitted to minors by law,
3.
intends to be insulting or harassing,
4.
intends to incite fighting or presents a likelihood of disrupting the School or an School event.
Materials may not be displayed or distributed during class periods, or during passing times between classes. Permission may be granted for display or distribution during lunch periods and after class hours in designated locations, as long as exits are not blocked and there is proper access and egress to the building.
Dress and Grooming See Parent’s Quick Guide Medications at school Before any medication or treatment may be administered to any student during school hours, the school shall require the written prescription from the child’s physician with detailed instructions, written promises of the physician and the legal guardian to forward any changes in the prescription or instructions to the school immediately upon change and to ensure delivery to the appropriate staff. This must be accompanied by the written authorization and waiver of the legal guardian. This document shall be kept on file in the main office of the School with the secured medical files.
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Only medication in its original prescription bottle labeled with the date of prescription, student’s name, and exact dosage will be administered and only in the presence of another adult. Legal guardians, or students authorized in writing by physician and legal guardians, may administer medication or treatment but only in the presence of an adult staff member assigned for that purpose. Electronic Communication Devices While on School property, in a School vehicle, or while attending School-sponsored or School-related activities, whether on or off School property, Students shall be permitted to possess and use wireless communication devices, provided they observe the following conditions: A.
Devices shall not be used in a manner that disrupts the educational process, or educational mission including, but not limited to, posing a threat to academic integrity or violating confidentiality or privacy rights of another individual. Unless an emergency situation exists that involves imminent physical danger or a certified employee authorizes the student to do otherwise, devices shall be turned off during the School day. They may be stored in the Student’s backpack during the School day, but may only be turned on and operated before and after the regular school day.
B.
When Students violate this prohibition, they shall be subject to disciplinary action, including but not limited to losing the privilege of bringing the device onto School property. In addition, an administrator may confiscate the device, which shall only be returned to the student’s legal guardian. All requests to confiscate these items must be complied with in a spirit of cooperation. If, upon confiscation, the School becomes aware of other misuse of the device, or, has a reasonable suspicion of other violations of school policy, the student may be disciplined for additional violations of this or other School policies. In other words, a Student loses his/her privacy rights in the device and information contained in the device, once a school policy is violated and the device confiscated so long as the School has a reasonable suspicion of misuse.
C.
Students are responsible for devices they bring to School. The School shall not be responsible for loss, theft, or destruction of devices brought onto School property.
D.
Students shall comply with any additional rules developed by the School concerning appropriate use of electronic communication devices.
E.
Students shall not utilize an electronic communication device in a manner that would violate the School’s Technology and Internet Acceptable Use Policy or its Student Code of Conduct.
F.
Examples of types of prohibited behavior involving electronic communication devices include, but are not limited to: a. text messaging on or off School Property during School hours to or from a student on School Property; b. sexting, which is the act of sending sexually explicit messages or photographs, primarily between mobile phones or other electronic communication devices; c. using digital cameras or camera phones to invade the privacy of others by transmitting unauthorized or derogatory photos or video clips to another person via email, to another camera phone or by posting it on the web; d. using digital cameras, camera phones, or any other device to cheat on examination; e. playing digital games; f. using digital cameras, camera phones, or any other device to harass or bully another.
A "wireless communication device" is a device that emits an audible signal, vibrates, displays a message, or otherwise summons or delivers a communication to the possessor. The following devices are examples of WCDs: cellular and wireless telephones, pagers/beepers, personal digital assistants (PDAs), BlackBerries/Smartphones, Wi-Fi-enabled or broadband access devices, two-way radios or video broadcasting devices, and other devices that allow a person to record and/or transmit, on either a real time or delayed basis, sound, video or still images, text, or other information. Students may not use WCDs on school property or at a school-sponsored activity to access and/or view Internet web sites that are otherwise blocked to students at school. During times when directed by the Chief Administrative Officer or his/her designee, WCDs shall be powered completely off (not just placed into vibrate or silent mode) and stored out of sight. The requirement that WCDs must be powered completely off will not apply when the student obtains prior approval from the Chief Administrative Officer. Students are prohibited from using WCDs to capture, record or transmit the words (i.e. audio) and/or images (i.e., pictures/video) of any student, staff member or other person in the school or while attending a school-related activity, without express prior notice and explicit consent for the capture, recording or transmission of such words or images. Using a WCD to take or transmit audio and/or pictures/video of an individual without his/her consent is considered an invasion of privacy and is not permitted, unless authorized by the Chief Administrative Officer.
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WCDs, including but not limited to devices with cameras, may not be possessed, activated or utilized at any time in any school situation where a reasonable expectation of personal privacy exists. These locations and circumstances include but are not limited to classrooms, locker rooms, shower facilities, bathrooms, and any other areas where students or others may change clothes or be in any stage or degree of disrobing or changing clothes, whether here or at another school district where a school activity or athletic event is occurring. The Chief Administrative Officer has authority to make determinations as to other specific locations and situations where possession of a WCD is absolutely prohibited. No expectation of confidentiality will exist in the use of WCDs on school premises/property. Students are prohibited from using a WCD in any way that might reasonably create in the mind of another person an impression of being threatened, humiliated, harassed, embarrassed or intimidated. See Policy 5517.01 – Bullying and Other Forms of Aggressive Behavior. Students are also prohibited from using a WCD to capture and/or transmit test information or any other information in a manner constituting fraud, theft, cheating, or academic dishonesty. Likewise, students are prohibited from using their WCDs to receive such information. Possession of a WCD by a student is a privilege that may be forfeited by any student who fails to abide by the terms of school policy, or otherwise engages in misuse of this privilege. Violations of school policy may result in loss of this privilege, disciplinary action (e.g. warnings, parental notification and conferences, suspension, expulsion), confiscation of the WCD (in which case, the device will only be released/returned to the student's legal guardian after the student complies with any other disciplinary consequences that are imposed) and/or referral to law enforcement if the violation involves an illegal activity (e.g. child pornography). Any search will be conducted in accordance with Search and Seizure policy. If multiple offenses occur, a student may lose his/her privilege to bring a WCD to school for a designated length of time or on a permanent basis. A person who discovers a student in possession of or using a WCD in violation of school policy is required to report the violation to the Chief Administrative Officer. Students are personally and solely responsible for the care and security of their WCDs. The Governing Authority assumes no responsibility for theft, loss, damage, or vandalism to WCDs brought onto its property, or the unauthorized use of such devices. Students and legal guardians are strongly encouraged to take appropriate precautions, if students have WCDs in their possession, to make sure the devices are not left unattended or unsecured. Legal guardians are advised that the best way to get in touch with their child during the school day is by calling the school office. Students may use school phones to contact legal guardians during the school day with permission of the Chief Administrative Officer. Students may use WCDs on a school bus or Governing Authority-provided vehicle during school-sponsored activities, at the discretion of the bus driver, classroom teacher, and/or sponsor/advisor. Distracting behavior that creates an unsafe environment will not be tolerated. Students participating in extra-curricular activities must contact their advisor or sponsor for his/her rules involving the use of WCDs after school hours or on after-school bus trips. Sponsors will set their rules and enforce consequences involving the use and/or misuse of these devices. Technology and Internet Acceptable Use The use of technology and computer resources at the School is a revocable privilege. Failure to abide by school policy may render you ineligible to use the school’s computer facilities and may bring additional disciplinary action. All users are expected to use the technology available at the School in a manner appropriate to the School’s academic and moral goals. Technology includes, but is not limited to, cellular telephones, beepers, pagers, radios, CD/MP3/DVD players, video recorders, video games, personal data devices, computers, other hardware, electronic devices, software, Internet, e-mail and all other similar networks and devices. Users are expected to be responsible and use Technology to which they have access appropriately. Obscene, pornographic, threatening, or other inappropriate use of Technology, including, but not limited to, e-mail, instant messaging, web pages, and the use of hardware and/or software which disrupts or interferes with the safety and welfare of the School community, is prohibited, even if such uses take place after or off School property (i.e., home, business, private property, etc.). Failure to adhere to school policy and the guidelines below will result in disciplinary action Unacceptable uses of Technology/Internet include but are not limited to:
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1.
Violating the conditions of federal and Ohio law dealing with students and employees’ rights to privacy. Trespassing in others' folders, work, or files; copying other people’s work or attempting to intrude onto other people’s files; using other users' e-mail addresses and passwords.
2.
Using profanity, obscenity or other language which may be offensive to another user; sending messages with derogatory or inflammatory remarks about an individual’s race, sex, age, disability, religion, national origin or physical attributes via the Internet or Technology; bullying, insulting, intimidating, or attacking others; transmitting any material in violation of federal or state law.
3.
Accessing profanity, obscenity, abusive, pornographic, and/ or impolite language or materials, accessing materials in violation of the Student Code of Conduct. A good rule to follow is to never view, send or access materials that you would not want your instructors and legal guardians to see. Should a student encounter any inappropriate materials by accident, he/she should report it to their instructors immediately.
4.
Violating copyright laws by illegally downloading or installing music, any commercial software, shareware, or freeware. You are required to strictly comply with all licensing agreements relating to any software. All copyright laws must be respected.
5.
Plagiarizing works through the Internet or other Technology. Plagiarism is taking ideas of others and presenting them as if they were original to the user.
6.
Damaging Technology devices, computers, computer systems or computer networks (for example, by the creation, introduction or spreading of computer viruses, physically abusing hardware, altering source codes or software settings, etc.).
7.
Using the Technology or the Internet for commercial purposes or activities, which is defined as offering or providing goods or services or purchasing goods of services for personal use, and includes, but is not limited to, the following:
8.
a.
any activity that requires an exchange of money and/or credit card numbers;
b.
any activity that requires entry into an area of service for which the School will be charged a fee;
c.
any purchase or sale of any kind; and
d.
any use for product advertisement or political lobbying.
Neither the Internet nor any other Technology may be used for any purpose which is illegal or against the School’s policies or contrary to the School’s mission or best interests.
All users are expected to be responsible, courteous and thoughtful when using Technology and the Internet. Common sense should prevail. The use of the School computer network system should be in support of education and research, consistent with the educational mission or objectives of the School and in accordance with federal law, Ohio law and the Student Code of Conduct. Students and Staff have no expectation of privacy with respect to the use of Technology, the Internet, intranet or e-mail. Maintenance and monitoring of the School network system may lead to the discovery that a user has or is violating school policy or the law. Violations of school policy, the Student Code of Conduct or the law may result in severe penalties, up to and including expulsion. The School makes no warranties of any kind; either expresses or implied that the functions or the services provided by or through the School technology system will be error-free or without defect. The School will not be responsible for any damage users may suffer, including but not limited to, loss of data, interruptions of service, or computer viruses. The School is not responsible for the accuracy or quality of the information obtained through or stored on the School system. The School will not be responsible for financial obligations arising through the authorized use of the system. In accordance with the Children’s Internet Protection Act (“CIPA”), the School has placed a filer on its Internet access as one step to help protect its users from intentionally or unintentionally viewing inappropriate material. The School blocks the categories that are determined to be potentially inappropriate. However, families must be aware that some material accessible via the Internet contains illegal, defamatory, inaccurate, or potentially offensive language and/or images. While the goal of the School is to use Internet resources to achieve educational goals, there is always a risk of students accessing other materials. Legal guardians should be aware of these risks. My signature attests that I have read the above Internet Acceptable Use Policy and I agree to abide by it.
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Academics The School’s unique location allows teachers and students to take advantage of sophisticated research laboratories and guest lecturers from an array of scientific researchers, professors and medical professionals. By engaging professionals from engineering, science, pharmaceutical, biomedical, technology and other companies to provide support for curriculum delivery and serve as project advisors, the School is well supported to connect to the community and develop educational experiences around community health and the environment. The school implements a unique virtual classroom environment to provide subject delivery and academic support, where professionals, teachers and students from anywhere in the world can collaborate with School teachers and students on joint projects and virtual teams during or after the school day throughout the year. The School will focus on developing the STEM +M habits of mind while providing opportunities for the students to explore their curriculum through problem based/discovery learning.
Student Profile: The Bio-Med Science School was created to offer students a different methodology with instruction while focusing on STEM + M disciplines. Our students will reflect the following: Engaged Learner Sense of Commu nity
Innovati ve
Persona l Agency
Problem Solver Collabor ative
Mastery Learning and Grading The School’s philosophical roots are grounded in the concept that all students will learn how to apply and implement their knowledge into their everyday lives and solving current global issues. The School’s staff, personnel, and support instructors will work with the students to develop a level of thinking that involves self-processing and a keen awareness of the knowledge they understand. Students are expected to master the Core Curriculum concepts. If Mastery of the curricular concept has not been achieved in the first attempt then students will be given additional time and remediation if needed. Mastery Scale High Performance Students have: • Completed assignment with-in original deadline or has made a valiant effort to grow academically to achieve such a rating • Student’s work has exceeded mastery expectations • Deep understanding of the learning outcome and reaches into high levels of thinking. (Analyzing, evaluation...) • Sophisticated communication of the learning outcome Proficient (Mastery Level) Students have: • Student’s knowledge and work reflects an understanding of the learning outcome • Student can apply knowledge to solve problems • Communication of the learning outcome is effective Not Yet Proficient Students have: • Partial understanding of the learning outcome concepts and skills • Provide limited evidence to connect learning outcomes • Communication of the standard is limited but developing No Evidence of Learning Necessary skills Students may have: • Inconsistently made curricular connections • Extreme difficulty reaching higher levels of thinking with the standard • Ineffective communication of the learning outcome • Needed to place more effort into content understanding
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• •
Not met the original collection date/deadline for the assignment Shown evidence of beginning level of work in their assignment.
Please note that when a school transcript needs generated for an outside purpose the School will use the following key: • • • •
High Performance - A Proficient – B (Bio-Med Science School Mastery level) Not Yet Proficient - C No Evidence of Learning Necessary skills – D/F
Student Success Plan See Parent’s Quick Guide Grade Reporting The School will be tracking student’s academic progress using a web based program called TRACKER. This program was created out of a National Science Foundation grant and specifically designed to track student’s academic progress reflecting mastery. Tracker will be available 24/7 once usernames and passwords have been assigned. Graduation Requirements See Parent’s Quick Guide Volunteer Hours Volunteer hours are a graduation requirement here at Bio-Med. The 130 hours must be completed by May 1st of the students graduating year. Hours completed must be documented and signed using the form included in this handbook or printing extra pages off of AIMS. Students may either use one sheet per organization and track all of their dates and hours together and turn that in at the end or they can turn in hours as they go. Students who do not complete the hour requirement will not receive their high school diploma. Hours can be done with just about any organization, neighborhood service or even for another organization requirement (Boy Scouts, 4-H, etc.) Any students who plan to do extended days of volunteer that conflict with our normal schools days must be mastered in all subjects in order for all of those hours to count towards their requirement. A student who is not mastered in all classes before leaving for their service will only be able to count for a portion of their hours as they are not keeping up with their requirements as a student here at Bio-Med. If a student is going to be gone for a service trip or missing extended days must fill out the form included in this handbook and return that before they leave. School and Student Safety All students are expected to conform to the Student Code of Conduct at School, on the School premises, at School activities or functions whether on or off the School premises and on transportation to and from School, if paid for or provided by the School and are subject to the School’s disciplinary process when they fail to do so. Student Code of Conduct All students are expected to conform to the Student Code of Conduct while at School, on School premises, at School activities or functions whether on or off the School premises, in any virtual or electronic environment where School sanctioned activities are conducted, and on transportation to and from School, if paid for or provided by the School. Students will be subject to the School’s disciplinary process when they fail to conform to the Student Code of Conduct. Respect for real and personal property; pride in one's work; achievement within the range of one's ability; and exemplary personal standards of courtesy, decency, and honesty shall be maintained in the school. It is the responsibility of students, teachers and administrators to maintain a classroom environment that: A. B. C. D. E.
allows teachers to communicate effectively with all students in the class; allows all students in the class the opportunity to learn; has consequences that are fair, and developmentally appropriate; considers the student and the circumstances of the situation; and enforces the student Code of Conduct/Student Discipline Code accordingly.
Students may be subject to discipline for violation of the Code of Conduct/Student Discipline Code even if that conduct occurs on property not owned or controlled by the Governing Authority but that is connected to activities or incidents that have occurred on property owned or controlled by the Governing Authority, or conduct that, regardless of where it occurs, is directed at a Governing Authority official or employee, or the property of such official or employee.
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Progressive Discipline First Level Offense 1.
Teacher explains or reviews class and School rules and warns the student of possible consequences.
2.
Teacher applies appropriate in school consequences including longer time-outs, or alternate areas for reflection, loss of privileges, detention, etc.
Second Level Offense 1. Teacher applies appropriate consequences based on the outcome of the First Level of Offense, including longer time-outs, or alternate areas for reflection, loss of privileges, detention, etc. 2. Teacher personally communicates the problem(s) with the student’s legal guardians. 3.
Teacher sends a written report home and a copy to the office.
Third Level Offense If actions taken at Levels 1 – 2 have not corrected the inappropriate behavior, or, if the student engaged in serious act(s) of misconduct, the Chief Administrative Officer may suspend the student from School, not to exceed ten School days. Fourth Level Offense If actions taken at Levels 1 -3 have not corrected the inappropriate behavior, or, if the student engaged in serious act(s) of misconduct, the Chief Administrative Officer may expel the student from School, not to exceed 80 days, unless one year is specifically authorized, or, unless the student is permanently excluded under Policy No. 273. Progressive discipline levels may be skipped for serious acts of misconduct at the discretion of the Chief Administrative Officer. Insubordination Insubordination is verbal or nonverbal refusal to comply with a reasonable request or directive while on school property or at any school related activity or event, including but not limited to chronic failure to complete academic work. Chronic insubordination may result in suspension and/or expulsion of the student as provided for under the Suspension and Expulsion policies. Sexual and Other Forms of Harassment Students have the right to learn in an environment untainted by sexual or other forms of harassment or discrimination. Offensive conduct which has the purpose or effect of unreasonably interfering the with the learning atmosphere or creating an intimidating, hostile, discriminatory, or offensive learning environment, or which disrupts the educational process or impedes the legitimate pedagogical concerns of the School, is strictly prohibited. Sexual harassment includes all unwelcome sexual advances, requests for sexual favors, and verbal or physical contacts of a sexual nature. Other prohibited conduct includes that which has the purpose or effect of creating an intimidating, hostile, discriminatory, or offensive learning environment on the basis of gender, religion, race, color, ethnicity, disability, and/or other legally protected category. The harassment by a student of a staff member or fellow student is strictly forbidden. Any student who is found to have harassed a staff member or student will be subject to discipline. The harassment of a student or a staff member should be reported immediately by the student or staff member to any teacher or to the Chief Administrative Officer or his/her designee. Any person who receives such a report shall immediately advise the Chief Administrative Officer or his/her designee or a Governing Authority member, who will investigate and take appropriate action in accordance with Governing Authority directives.
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Anti-Harassment, Intimidation and Bullying The School prohibits acts of harassment, intimidation, or bullying (including cyber-bullying) of any student on school property or at school-sponsored events (any event conducted on or off School property, including buses and other School related vehicles, that is sponsored, recognized or authorized by the Governing Authority). A safe and civil environment in the School is necessary for students to learn and achieve high academic standards. Harassment, intimidation and bullying, like other disruptive or violent behaviors, are conduct that disrupts both a student’s ability to learn and the School’s ability to educate its students in a safe environment. Since students learn by example, the School administrators, faculty, staff and volunteers should be commended for demonstrating appropriate behavior, treating others with civility and respect, and refusing to tolerate bullying. “Harassment, intimidation, or bullying” means either of the following: 1) any intentional, written, verbal, graphic, or physical act that a student or group of students has exhibited toward another particular student more than once and the behavior both causes mental or physical harm to the other student; and is sufficiently severe, persistent or pervasive that it creates an intimidating, threatening or abusive educational environment for the other student; or 2) violence within a dating relationship. The definition of “harassment, intimidation or bullying” also includes the above described acts which are electronically generated, stored or transmitted. The School reserves the right to discipline students’ off campus behavior which substantially disrupts the School’s educational process or mission, or threatens the safety or well-being of a Student or Staff member. Factors which may be considered in determining whether the behavior warrants discipline include, but are not limited to, the following: (1) whether the behavior created material and substantial disruption to the educational process or the School’s mission due to the stress on the individual(s) victimized or the time invested by Staff in dealing with the behavior or its consequences; (2) whether a nexus to on-campus activities exists; (3) whether the behavior creates a substantial interference with a Student’s or Staff member’s security or right to educate and receive education; (4) whether the behavior invades the privacy of others; or (5) whether any threat is deemed to be a true threat by the administration or Governing Authority, using factors and guidelines set out by the courts or by common sense, reasonable person standards. Some acts of harassment, intimidation, bullying and cyber-bullying may be isolated incidents requiring that the School respond appropriately to the individuals committing the acts. Other acts may be so serious or part of a larger pattern of harassment, intimidation, bullying or cyber-bullying that they require a response either in the classroom, School building, or by law enforcement officials. Consequences and appropriate remedial actions for students who commit an act of harassment, intimidation, bullying or cyber-bullying range from positive behavioral interventions up to and including suspension or expulsion. Due process procedures for suspension and expulsion will be followed, as provided for under R.C. 3313.66. The disciplinary procedures and code of conduct of the School shall be followed and shall not infringe on any student’s First Amendment rights under the United States Constitution. All School personnel, volunteers and students are required to report prohibited incidents of which they are aware to the Head administrator title MC» or his/her designee. All other persons may report prohibited incidents of which they are aware to the Chief Administrative Officer or his/her designee. Anonymous communications, if necessary, may be made by telephone, electronic mail, or in writing. The Chief Administrative Officer or his/her designee is then responsible for determining whether an alleged incident constitutes a violation of school policy. In so doing, the Chief Administrative Officer or his/her designee shall conduct a prompt and thorough investigation of the reported incident, and prepare a report documenting the prohibited incident that is reported (See attached Form for Reporting Incidents of Harassment Intimidation and Bullying, forms can also be found at the school counselor). Once an investigation is completed, if the reported incident has been substantiated, the legal guardian of any student involved in the prohibited incident shall be notified. To the extent permitted by R.C. § 3319.321 and the Family Educational Rights and Privacy Act of 1974 (20 U.S.C. 1232g), legal guardians have access to any written reports pertaining to the prohibited incident, and, if the School has a website, the School shall post this summary of reported incidents on the School website. Semiannually, the Chief Administrative Officer will provide the Governing Authority President with a written summary of all reported incidents. All School personnel, volunteers and Students shall be individually immune from liability in a civil action for damages arising from reporting an incident in accordance with school policy. The School prohibits reprisal or retaliation against any victim or person who reports an act of harassment, intimidation or bullying. The consequence and appropriate remedial action for a person who engages in reprisal or retaliation shall be determined by the Chief Administrative Officer or his/her designee after consideration of the nature and circumstances of the act, in accordance with School policies and procedures. The School shall implement the following strategy for protecting victims: supervise and discipline offending students fairly and consistently; provide adult supervision during recess, lunch time, bathroom breaks and in the hallways during times of transition; maintain contact with legal guardians of all involved parties; provide counseling for the victim if assessed that it is needed; inform School personnel of the incident and instruct them to monitor the victim and the offending party for the indications of harassing, intimidating and bullying behavior. Personnel are to intervene when prohibited behaviors are witnessed; check with the victim daily to
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insure that there has been no incidents of harassment/intimidation/bullying or retaliation from the offender or other parties. Harassment, intimidation and bullying behavior can take many forms and can vary dramatically in seriousness and impact on the targeted individual and other students. Accordingly, there is no one prescribed response to verified acts of harassment, intimidation and bullying. While conduct that rises to the level of “harassment, intimidation or bullying” will warrant disciplinary action whether and to what extent to impose disciplinary action (i.e., detention, in- and out-ofschool suspension, or expulsion) is a matter left in the professional discretion of the Chief Administrative Officer. The following procedure sets forth possible interventions for the Chief Administrative Officer to enforce the prohibition against harassment, intimidation or bullying. Anonymous complaints that are not otherwise verified, however, shall not be the basis for disciplinary action. 1.
Non-disciplinary Interventions When verified acts of harassment, intimidation or bullying are identified early and/or when such verified acts do not reasonably require a disciplinary response, students may be counseled as to the definition of harassment, intimidation or bullying, its prohibition and their duty to avoid any conduct that could be considered harassing, intimidating or bullying. If a complaint arises out of conflict between students or groups of students, peer mediation may be considered. Special care, however, is warranted in referring such cases to peer mediation. A power imbalance may make the process intimidating for the victim and therefore inappropriate. The victim’s communication and assertiveness skills may be low and could be further eroded by fear resulting from past intimidation and fear of future intimidation. In such cases, the victim should be given additional support. Peer mediation may be deemed inappropriate to address the concern at the discretion of the School administration.
2.
Disciplinary Interventions When acts of harassment, intimidation and bullying are verified and a disciplinary response is warranted, students are subject to the full range of disciplinary consequences. In and out-of-school suspension may be imposed only after informing the accused perpetrator of the reasons for the proposed suspension and giving him/her an opportunity to explain the situation. Expulsion may be imposed only after a hearing before the Governing Authority, a committee of the Governing Authority or an impartial hearing officer designated by the Governing Authority in accordance with Governing Authority policy. This consequence shall be reserved for serious incidents of harassment, intimidation or bullying and/or situations where past interventions have not been successful in eliminating prohibited behaviors.
Nothing in school policy prohibits a victim from seeking redress under any provision of Ohio law that may apply. The School may form a prevention task force and/ or programs to educate students about school policy, such as holding an assembly on harassment, intimidation and bullying for legal guardians and students, to raise the level of awareness and help prevent the prohibited conduct. The School may also provide training, workshops, or courses on school policy to Staff and volunteers who have direct contract with students. Anti-Hazing The School prohibits all acts of hazing. Hazing, like other violent and disruptive behaviors, is conduct that disrupts both a student’s ability to learn and the School’s ability to educate its students in a safe and civil environment. Hazing or hazing activity means doing any act or coercing another, including the victim, to do any act of initiation into any student or other organization that causes or creates a substantial risk of causing mental or physical harm to any person. For purposes of school Anti-Hazing policy, mental harm means mental stress, anxiety, physical injury, sickness, injury to feelings, humiliation, mental anguish, and/or depression, connected to and arising from the hazing activity. Permission, consent or assumption of risk by an individual subjected to hazing does not lessen the prohibition contained in school policy. Hazing activities of any type are inconsistent with the educational process and are prohibited at all times, regardless of whether the activity occurs on or off of property owned, used or controlled by the School, so long as the hazing activity is in any way connected to the activities or incidents that have occurred on property owned, used or controlled by the School. School policy will be actively enforced at all times. Hazing is a violation of school policy separate and distinct from harassment or other prohibited conduct. No student, including leaders of student organizations, may plan, encourage or engage in any hazing activity. Students having engaged in hazing activity and who fail to abide by school policy are subject to disciplinary action including suspension,
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expulsion, removal or permanent exclusion as set forth elsewhere in school policy manual, and may be liable for civil and criminal penalties pursuant to State law. Staff is to be particularly alert to possible conditions, circumstances or events, which might include hazing. If hazing or planned hazing is discovered, involved students are informed by the discovering Staff member of the prohibition contained in school policy and are required to end all hazing activities immediately. All hazing incidences are reported immediately to the Chief Administrative Officer or his/her designee. No Staff shall encourage, permit, condone or tolerate any hazing activities, and Staff who fails to abide by school policy may be subject to disciplinary action and may be liable for civil and criminal penalties pursuant to State law. Gang Activity The Governing Authority believes gangs or gang activity create an atmosphere that seriously disrupts the educational process. Students are prohibited from engaging in gang activities while at School, on School property, or at School -sponsored events. As used herein the term “gang” means any ongoing organization, association, or group of three or more persons, whether formal or informal, having as one of its primary activities the commission of one or more criminal acts, which has an identifiable name or identifying sign or symbol, and whose members individually or collectively engage in or have engaged in a pattern of criminal gang activity. The term “gang activity” shall mean any conduct engaged in by a student 1) on behalf of any gang; 2) to perpetuate the existence of any gang; 3) to effect the common purpose and design of any gang; or 4) to represent a gang affiliation, loyalty or membership in any way while on School grounds or while attending a School function. These activities include recruiting students for membership in any gang and threatening or intimidating other students or employees to commit acts or omissions against his/her will in furtherance of the common purpose and design of any gang. A violation of school policy is grounds for suspension or expulsion from the School. Disorder and Demonstration The School recognizes the right of each Student to attend the School for the purpose of receiving an education. The disruption of the educational program of the School by disorder or any other purposeful activity will not be countenanced. For purposes of school policy, disorder shall be any deliberate activity by an individual or a group, whether peaceful or violent, which interferes with the normal operation of the School. The School, having the responsibility for providing an educational program for the students of the School, shall have the authority to preserve order for the proper functioning of that program. Students shall not be disturbed in the exercise of their constitutionally guaranteed rights to assemble peaceably and to express ideas and opinions, privately or publicly, provided that such exercise does not infringe on the rights of others and does not interfere with the operation of the School. Drug Prevention The School recognizes that the misuse of drugs is a serious problem with legal, physical, and social implications for the whole community. For purposes of school policy, “drugs” shall mean: • • • •
all controlled substances as so designated and prohibited by applicable Federal and Ohio law; all chemicals which release toxic vapors; all alcoholic beverages; any prescription or patent drug, except those for which permission to use in school has been granted pursuant to Governing Authority policy; • anabolic steroids; and • any substance that is a “look-alike” to any of the above. The School prohibits the use, possession, concealment, or distribution of any drug or any drug-related paraphernalia, as the term is defined by law, on School grounds, on School vehicles and vehicles used for School-sponsored events, and at any School -sponsored event. The School’s drug prevention program:
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Emphasizes the prevention of drug use; A. B. C. D. E. F. G.
Provides for a comprehensive, age-appropriate, developmentally-based drug and alcohol education and prevention program which: addresses the legal, social, psychological, and health consequences of drug and alcohol use; provides information about effective techniques for resisting peer pressure to use illicit drugs and alcohol; assists students to develop skills to make responsible decisions about substance abuse and other important health issues; promotes positive emotional health, self-esteem, and respect for one's body; advises students that the use of illicit drugs and the unlawful possession and use of alcohol is wrong and harmful; and meets the minimal objectives as stated in the essential performance objectives for health education as established by the State Department of Education.
Disciplinary sanctions, up to and including expulsion and referral for prosecution, will be imposed on students who violate this Policy. The sanctions may include, together with punitive action, voluntary referral to appropriate persons or agencies for screening and assessment. Such referral may only be made to qualified and properly licensed individuals or programs. The School will provide information about any drug and alcohol counseling and rehabilitation and re-entry programs available to Students and will direct students and their legal guardians to the appropriate programs. School policy serves as notification to legal guardians and students that compliance with school policy and other standards of conduct is mandatory. The Chief Administrative Officer or his/her designee will conduct a biennial review of the School’s program to determine its effectiveness and implement changes as needed and to ensure that disciplinary sanctions are consistently enforced. The School will provide a Student assistance program which includes guidelines for prevention, intervention, referral, treatment, and after-care. Such a program must be comprehensive in nature addressing all issues affecting students' academic, social, and emotional well-being in the educational setting which may negatively affect behavior and interfere with their ability to learn. The School’s policies and procedures on Search and Seizure, Suspension and Expulsion, and Permanent Exclusion, among others, will be are complied with fully in dealing with students suspected of drug use or possessing or distributing drugs in School. The School shall develop a curriculum for instruction in the harmful effects of and legal restrictions against the use of drugs of abuse, alcoholic beverages, and tobacco for students at each grade level and conduct such in-service training programs for Staff members necessary to ensure effective teaching about drugs and assistance to Students with drug problems. The Chief Administrative Officer or his/her designee shall establish administrative guidelines necessary to implement school policy. Such guidelines shall ensure that the proper notice regarding the use of anabolic steroids is posted in all School locker rooms used by students in grades 7- 12, as applicable. Search and Seizure The Governing Authority recognizes that the privacy of students or their belongings may not be violated by unreasonable search and seizure and directs that no student be searched without reasonable suspicion or in an unreasonable manner. The Governing Authority acknowledges the need for in-school storage of student possessions and shall provide storage places, including desks and lockers, for that purpose. Such spaces remain the property of the Governing Authority and, in accordance with law, may be the subject of random search. Where locks are provided for such places, students may lock them against incursion by other students, but in no such places shall students have such an expectation of privacy as to prevent examination by a school official. The Governing Authority directs the Chief Administrative Officer to conduct a routine inspection at least annually of all such storage places. School lockers, desks, and property are on loan to the students and remain the property of the School. They may be inspected and reclaimed at any time. Students must not keep prohibited items, including drugs, drug paraphernalia, firearms, explosives, and property belonging to others within their lockers, backpacks or desks. Students must open their lockers at the request of School officials. A student shall have the opportunity to be present during the search of his or her locker, desk, or other property unless the student is absent from School or the safety or welfare of the School or an individual necessitates a search during the student's absence. School authorities are charged with the responsibility of safeguarding the safety and well-being of the students in their care. In the discharge of that responsibility, school authorities may search the person or property, including vehicles, of a
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student, with or without the student's consent, whenever they reasonably suspect that the search is required to discover evidence of a violation of law or of school rules. The extent of the search will be governed by the seriousness of the alleged infraction and the student's age. This authorization to search shall also apply to all situations in which the student is under the jurisdiction of the Governing Authority. Administrators are permitted to conduct a random search of any student's locker and its contents at any time, providing proper notice has been posted in the locker areas of each building. When on School grounds, students and their personal property may be searched if a school official has grounds to believe the search may turn up evidence that the student has violated or is violating the law or School rules. Search of a student's person or intimate personal belongings shall be conducted by the Chief Administrative Officer if they are the same gender as the student. If not, the Chief Administrative Officer may select a designee of the student's gender. All searches must be performed in the presence of another staff member of the same gender, and only in exceptional circumstances when the health or safety of the student or of others is immediately threatened. However, no strip searches may be conducted by school personnel. Administrators are authorized to arrange for the use of a breath-test instrument for the purpose of determining if a student has consumed an alcoholic beverage. It is not necessary for the test to determine blood-alcohol level, since the Governing Authority has established a zero tolerance for alcohol use. The Governing Authority also authorizes the use of canines, trained in detecting the presence of drugs or devices, when the Chief Administrative Officer has reasonable suspicion that illegal drugs or devices may be present in a school. This means of detection shall be used only to determine the presence of drugs in locker areas and other places on school property where such substances could be concealed. Canine detection must be conducted in collaboration with law enforcement authorities or with organizations certified in canine detection and is not to be used to search individual students unless a warrant has been obtained prior to the search. Students have no expectation of privacy with respect to the use of the internet, intranet or e-mail. Routine maintenance and monitoring of the School network system may lead to the discovery that a student has or is violating school policy or the law. Except as provided below, a request for the search of a student or a student's possessions will be directed to the Chief Administrative Officer who shall seek the freely offered consent of the student to the inspection. Whenever possible, a search will be conducted by the Chief Administrative Officer in the presence of the student and a staff member other than the Chief Administrative Officer. A search prompted by the reasonable belief that health and safety are immediately threatened will be conducted with as much speed and dispatch as may be required to protect persons and property. The Chief Administrative Officer shall be responsible for the prompt recording in writing of each student search, including the reasons for the search; information received that established the need for the search and the name of informant, if any; the persons present when the search was conducted; any substances or objects found; and the disposition made of them. The Chief Administrative Officer shall be responsible for the custody, control, and disposition of any illegal or dangerous substance or object taken from a student. Violations of school policy, the student code of conduct or the law may result in severe penalties, up to and including expulsion. Guidelines The following guidelines shall be used when school administrators have reason to suspect that an illegal or dangerous substance or object or stolen property may be in the possession of a student: A. B.
C. D. E. F.
All requests or suggestions for the search of a student or his/her possessions shall be directed to the Chief Administrative Officer or the person in charge of the students while out of the School. Wherever possible, before conducting the search, the Chief Administrative Officer shall notify the student, request his/her consent to the inspection if other than his/her locker, and inform the student that s/he may withhold consent. Such consent, if offered, shall be given voluntarily and with the knowledge that it could have been withheld. The Chief Administrative Officer shall conduct the search, however, with or without the consent. Wherever possible, an adult third party shall be present at any search of a student or his/her possessions. The Chief Administrative Officer may conduct a student search upon reasonable suspicion to suspect the presence of an illegal or dangerous substance or object, or anything contraband under school rules. The Chief Administrative Officer shall be responsible for the custody, control, and disposition of any illegal or dangerous substance or object taken from a student, whether during a student search or otherwise. Wherever possible, the student shall be present at any search of his/her possessions.
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G. H.
The Chief Administrative Officer shall be responsible for the prompt recording of each student search. The record shall be in writing and shall include the reasons for the search, the persons present, the objects found, and the disposition made of them, and shall be kept in a secure location in his/her office. Whenever the search is prompted by the reasonable suspicion that possession of a substance or object immediately threatens the safety and health of the student or others, the Chief Administrative Officer shall act with as much speed and dispatch as is required to protect persons and property in the school while keeping clearly in mind the student's rights and the potential consequences of inappropriate or hasty action.
Reasonable Suspicion As used in this section, "reasonable suspicion for a search" means grounds sufficient to cause an adult of normal intellect to believe that the search of a particular person, place, or thing will lead to the discovery of evidence that the student: A. B. C.
has violated or is violating a rule or behavioral norm contained in the student handbook; has violated or is violating a particular law; possesses an item or substance which presents an immediate danger of physical harm or illness to students and staff or School property.
Lockers and Other Storage Areas Provided for Student Use All lockers and other storage areas provided for student use remain the property of the School. These lockers and storage areas are subject to inspection, access for maintenance, and search pursuant to these guidelines. A student using the locker or storage area has, by statute, no expectation of privacy in that locker or storage area or the contents contained. No student shall lock or otherwise impede access to any locker or storage area except with a lock provided by or approved by the Chief Administrative Officer. Unapproved locks will be removed and destroyed. The Chief Administrative Officer may search student lockers and storage areas and the contents contained therein at any time for any justifiable reason. The Chief Administrative Officer may, at any time, request assistance of the law enforcement agency having jurisdiction over the facilities of the School. The law enforcement officer must have probable cause, however, to conduct a search of the lockers and storage areas and the contents contained therein. Desks and Other Storage Areas A desk or any other storage area in the school provided for student use as well as the contents contained therein may be searched when the Chief Administrative Officer has reasonable suspicion for a search. Vehicles Any vehicle brought on School premises by a student may be searched when the Chief Administrative Officer has reasonable suspicion to justify the search. One of the conditions for granting permission for a student to bring a student-operated vehicle onto school premises is written consent by the student driver, the owner of the vehicle, and the legal guardian of the student to allow search of that vehicle. Refusal by any of the parties to provide or allow access to a vehicle at the time of a search request shall be cause for terminating the privilege without further hearing. Searches of vehicles of staff members or visitors shall be conducted by law enforcement personnel. Student The personal search of a student may be conducted by the Chief Administrative Officer when s/he has reasonable suspicion for a search of that student. Authorized searches of the student's person are:
A. B. C. D.
the student's pockets; purses, briefcases, or any other object in the possession of the student; a "pat down" of the exterior of the student's clothing and the removal of any item identified; removal of an article of exterior clothing such as a jacket.
Strip searches are to be conducted only by law enforcement personnel.
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Personal searches should be conducted in a private room by a person of the same gender as the student and designated by the Chief Administrative Officer. At least one (1) but not more than three (3) additional staff members of the same gender as the student being searched shall witness but not participate in the search. At the request of the student to be searched, an additional person of the same gender as the student designated by the student, and then reasonably available on school premises, shall witness the search. The student's legal guardians shall be notified of the search as soon as reasonably possible. Use of Dogs The Governing Authority has authorized the use of specially-trained dogs to detect the presence of drugs and devices such as bombs on school property under the following conditions: A. B. C. D. E.
The presence of the dogs on school property must be authorized, in advance, by the Chief Administrative Officer or be pursuant to a court order or warrant. The dog must be handled by a law enforcement officer or a contracted person specially trained to safely and competently work with the dog. The dog is represented by the Sheriff or Chief of the law enforcement agency providing the service as capable of accurately detecting drugs and/or devices. The dog will be allowed to examine a student's possessions, including vehicles. The dog may be allowed to examine school property such as lockers as permitted by the Chief Administrative Officer. Any limitation as to areas of school property to be examined by the dog shall be established by the Chief Administrative Officer at the time the use of dogs is authorized.
Method of Search The scope of any search should be limited by the reasonable suspicion that motivated the search. If an item is found that leads to reasonable suspicion that additional, correlated items may also exist, the search may be extended. If the initial search produces no evidence of contraband, there should be no extension of the search based on simple curiosity. Items Found Anything found in the course of a search which is evidence of a student violation of school rules or Federal/State laws may be seized and admitted as evidence in any suspension or expulsion proceeding if it is tagged for identification at the time it is seized and kept in a secure place by the Chief Administrative Officer until it is presented at the hearing. It may also be turned over to any law enforcement officer after proper notation and receipt. Expulsion and Suspension Policies The Chief Administrative Officer or his/her designee may suspend a student for up to ten (10) School days. The Chief Administrative Officer may expel a student for up to eighty (80) school days and in some instances one (1) year. In the event that, in the opinion of the Chief Administrative Officer or his/ her designee, a student's presence at the School creates a health risk, presents a danger to other persons or property or seriously disrupts the functions of the School, the student may be removed from the premises without formal suspension or expulsion procedures, with notice and procedures to follow the removal in accordance with R.C. §3313.66. A student shall be expelled for one (1) year for bringing a firearm to the School or onto School Property (any Property owned, used or leased by the School for the School, School extracurricular or School-related events). A student may also be expelled for a period not to exceed one (1) year for: 1.
bringing a firearm to an interscholastic competition, an extracurricular event, or any other School program or activity that is located at a School or on School Property;
2.
bringing a knife to the School, onto School Property or to an interscholastic competition, an extracurricular event or any other program or activity sponsored by the School or which the School is a participant;
3.
possessing a firearm or knife at School , on School Property, or at an interscholastic competition, an extracurricular event, or any other School program or activity which firearm or knife was initially brought onto School Property by another person;
4.
committing an act that is a criminal offense when committed by an adult that results in serious physical harm to persons or serious physical harm to property;
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5.
making a bomb threat to a School building or to any premises at which a School l activity is occurring at the time of the threat.
A firearm is defined as any weapon, including a starter gun, which will or is designed to or may readily be converted to expel a projectile by the action of an explosive, the frame or receiver of any such weapon, any firearm muffler or silencer, or any destructive device. A destructive device, includes but is not limited to, any explosive, incendiary, or poison gas, bomb, grenade, rocket having a propellant charge of more than four (4) ounces, missile having an explosive or incendiary charge of more than one quarter ounce, mine, or other similar device. A knife is defined as any cutting instrument consisting of at least one sharp blade. The specific circumstances under which the Chief Administrative Officer may modify a one (1) year expulsion could include: 1.
a recommendation from the group of persons knowledgeable of the student's educational needs in accordance with The Individual with Disabilities Education Act;
2.
the student was unaware that s/he was possessing a firearm or knife;
3.
the student did not understand that the item s/he possessed was considered a firearm or knife;
4.
the student brought the item to School as part of an educational activity and did not realize it would be considered a firearm or knife; and
5.
the student may be eligible for participation in an alternative program.
A student may be expelled for up to eighty (80) days for serious misconduct or rules violations, or for other just cause. During the period of suspension, removal, or expulsion the student may not attend or participate in any School functions without permission from the Chief Administrative Officer. The student may enter School facilities only when given permission by the Chief Administrative Officer or if accompanied by a legal guardian who accepts responsibility for the student's actions and/or behavior at the facility. While serving an out-of-school suspension or expulsion, the Governing Authority does authorize students to receive instructional services from the School. If students are authorized to receive instructional services from the School, then such instructional services shall include the following: •
To be determined at the time of suspension.
The Governing Authority also authorizes the Chief Administrative Officer to suspend a student from any or all co-curricular or extracurricular activities for misconduct or rules violations. The length of suspension shall be determined by the Chief Administrative Officer commensurate with the seriousness of the student's misconduct or rules violations in accordance with the Code of Conduct. Participation in extra-curricular activities is a privilege and not a right. Accordingly, students prohibited from participating in all or part of any extra-curricular activity, are not entitled to notice, hearing or appeal rights. If the Chief Administrative Officer determines that a student's behavior on a School vehicle violates School rules, s/he may suspend the student from School bus riding privileges for the length of time deemed appropriate for the violation and remediation of the behavior. The Governing Authority authorizes the Chief Administrative Officer the option to require a student to perform community service in conjunction with, or in place of a suspension or expulsion, except when an expulsion is imposed for bringing a firearm to the School or onto School Property. The Governing Authority will hear the appeal of a suspension or an expulsion. The Chief Administrative Officer shall be responsible for implementing school policy and ensuring compliance with applicable laws. A copy of this Policy is to be posted in common areas of the School and made available to students and legal guardians upon request.
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Due Process Rights Suspension The following procedure does not apply to in-School suspensions. The Chief Administrative Officer may suspend a student if the following procedure is met: 1.
Prior to the imposition of the suspension, a written Notice of Intent to suspend will be given to the student, which contains the following: a.
The reasons for the intended suspension; and
b.
If the suspension is based on one of the serious criminal offenses for which permanent exclusion is allowed, and if the student is age 16 or older, the notice must also indicate the possibility that the Chief Administrative Officer may seek permanent exclusion.
2.
The student must be allowed an informal hearing before the Chief Administrative Officer or his/her designee to challenge the reasons for the intended suspension or otherwise explain his actions. The student is not entitled to call witnesses at this informal hearing.
3.
Within one School day after the suspension is imposed, the Chief Administrative Officer or his/her designee shall provide written notification to the legal guardian of the student and the treasurer of the Governing Authority of the suspension. The notice must contain the following: a.
The reasons for the suspension;
b.
Notification of the right to appeal to the Governing Authority or its designee. The intent to appeal must be in writing and received by the Governing Authority within 14 days after receiving the notice.
c.
The right to representation at all appeals;
d.
The right to a hearing before the Governing Authority or its designee; and
e.
The right to request that the hearing be held in executive session.
If the suspension is based on one of the serious criminal offenses for which permanent exclusion is allowed, and the student is age 16 or older, the notice must also indicate the possibility that the Chief Administrative Officer may seek permanent exclusion. Suspensions imposed during the last ten days of the school year may be carried over into the following school year. However, only the Chief Administrative Officer may impose a carryover suspension. Expulsion Only the Chief Administrative Officer may expel a student. The following procedure is required: 1.
2.
Prior to the imposition of the expulsion, the Chief Administrative Officer must provide not only the student, but also the legal guardian written notice of his intention to expel. The notice must include the following: a.
The reasons for the intended expulsion; and
b.
The time and place for a hearing, which must be not less than three nor more than five school days after giving the notice, unless the period is extended by the Chief Administrative Officer at the request of the student, his/her legal guardian or representative. The legal guardian must be sent written notice of any extension, and the subsequent notice should contain the same information required in the original notice.
c.
If the student is age 16 or older and the expulsion is for one of the serious criminal offenses for which permanent exclusion is allowed, the notice must also indicate the possibility that the Chief Administrative Officer may seek permanent exclusion.
A hearing must be scheduled not less than three or more than five school days after giving the notice, for the student and his/her legal guardian or representative to appear in person
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before the Chief Administrative Officer to challenge the reasons for the expulsion or otherwise explain his/her actions. 3.
Within one school day after the expulsion is imposed, the Chief Administrative Officer shall provide written notification to the legal guardian of the student and the treasurer of the Governing Authority of the expulsion. The notice must include the following: a.
The reasons for the expulsion;
b.
Notification of the right to appeal to the Governing Authority or its designee. The intent to appeal must be in writing and received by the Governing Authority within 14 days after receiving the notice.
c.
The right to representation at all appeals;
d.
The right to an appeal hearing before the Governing Authority or its designee;
e.
The right to request that the hearing be held in executive session;
f.
If the expulsion is based on one of the serious criminal offenses for which permanent exclusion is allowed, and the student is age 16 or older, the notice must also indicate the possibility that the Chief Administrative Officer may seek permanent exclusion;
g.
When the Chief Administrative Officer expels a student for more than twenty days or for any period of time extending into the next semester or academic year, the School shall provide, along with this notice, the student and his/her legal guardian with information about services or programs offered by public and private agencies that work toward improving those aspects of the student’s attitudes and behaviors that contributed to the incident giving rise to the expulsion. The information must include names, addresses, and phone numbers or the appropriate public and private agencies.
During the period of expulsion, the School may, but is not required to, continue educational services in an alternative setting. The Chief Administrative Officer is required to follow through on expellable offenses even if the student in question withdraws from the School prior to the hearing or the Chief Administrative Officer’s decision. The Chief Administrative Officer may apply any remaining part or all of the period of expulsion into the following year. Reference Policy 5610 for more information
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Appendices
32
Early Dismissal for Extracurricular Events Date________________
Student Name_________________________________________________________ Home School District_________________________________________
Extracurricular Event: ____________________________________________ Student’s Role in the Extracurricular Event__________________________________ Time of Event____________________
Date of Event___________________
Time of Early Dismissal___________________
Student Signature ___________________________________________________
Parent Name (please print) _____________________________________________
Parent Signature_____________________________________________________
CAO Approval Signature ________________________________________________
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Additional Community Service/Volunteer Work Verification Form: Please note below any additional service you have done outside of service days coordinated by BIO-MED Science Academy. A separate form must be completed and signed for each place of service in order for the experience to count toward your community service hours that will be listed on your transcript. If there is a place you volunteer regularly, complete one form each school year to keep track of your hours. If you do volunteer work through a school sponsored club, please have the advisor sign this form. Please return completed forms to Miss Hammond. Student Name: _______________________________________ Class of: __________________ Location of Service Work/Agency Name: _________________________________________________________________ Agency Address: ____________________________________________ Agency Phone Number: ____________________ Date(s) of Service: ___________________________________________________________________________________ Total Number of Hours Volunteered: ___________ Description of Tasks Performed: _____________________________________________________________________________________ _____________________________________________________________________________________ Agency Supervisor/Representative: _________________________ __________________________ ______________ print sign date Parent/Guardian: _________________________ __________________________ ______________ print sign date Student: _________________________ __________________________ ______________ print sign date
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Physician’s Request for Medication Form The following student is under my care and should receive the medication indicated below. It is not possible to arrange for this medication to be taken at home under the supervision of a parent, and therefore, must be taken during school hours. Name of Student: ___________________________________________________________________________ Address: ____________________________________________________________________________________ City/State/Zip: _______________________________________________________________________________ Name of Prescribed Medication and Dosage: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Number of Times/Intervals Medication is to be administered: _______________________________________ Dates Administration to Begin and End: ___________________________________________________________ Adverse or severe reaction that should be reported: _____________________________________________________________________________________________ _____________________________________________________________________________________________ Special Instructions for Administration of Medication: _____________________________________________________________________________________________ _____________________________________________________________________________________________ This medication can be safely administered by non-medical personnel: Yes
No
(Physician’s Name)
(Phone Number)
(Physician’s Signature)
(Date)
Bullying, Harassment, or Intimidation Reporting Form 35
Please complete all of the information to the best of your ability. Please print legibly. Today’s date ________/_________/20________ Person Reporting Incident: Name ______________________________________________________________________________________ Phone (________) _________-__________ Email __________________________________________________ Place an in the appropriate box: Student
Student (witness/bystander)
Parent/guardian
Close adult relative
School staff member
1. Name of student victim ___________________________________________________________________ 2. Name(s) of alleged offender(s) (if known)
Age
Is he/she a student? Yes
No
Yes
No
Yes
No
3. On what date(s) did the incident happen? ______/______/______ _____/______/______ _____/______/______ Mo/day/year Mo/day/year Mo/day/year 4. Where did the incident happen (choose all that apply)? On school property On a school bus
At school-sponsored activity or event off school property On the way to/from school
5. What did the alleged offender(s) say or do? ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ _________________________________________________ (Attach a separate sheet if necessary) 6. Why did the bullying, harassment, or intimidation occur? (Attach a separate sheet if necessary)
_____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ ____________________________________________ (Attach a separate sheet if necessary) 7. Is there any additional information you would like to provide? ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ______________________________________________________ (Attach a separate sheet if necessary)
Signature ____________________________________ Date ____/_____/______
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