English - Registration Packet

Midland Senior High School Registrar - (432) 689-1111

Data Entry Clerk- (432) 689-1118

Fax - (432) 689-1144

STUDENT INFORMATION (PLEASE PRINT):

FULL NAME: _________ _

BIRTHDATE: -----------

DI D STUDENT RECEIVE SERVICES IN SPECIAL EDUCATION?

WAS STUDENT ON A 504 PLAN?

WAS STUDENT IN AN ESL (ENGLISH AS SECOND LANGUAGE) PROGRAM?

HAS YOUR CHILD EVER ATTENDED A MIDLAND ISO SCHOOL?

YES NO

YES NO

YES NO

YES NO

IF YES, WHICH CAMPUS WAS LAST ATTENDED? _____________ _

PREVIOUS CAMPUS INFORMATION:

NAME OF PREVIOUS CAMPUS: ------------

ADDRESS: ------------------

CITY: STATE: ZIP CODE:-------- --- ---

PHONE: FAX: --------

ATTENTION SCHOOL REGISTRAR: PLEASE SEND THE FOLLOWING RECORDS:

• BIRTH CERTIFICATE

• SOCIAL SECURITY CARD

• IMMUNIZATION RECORDS

• WITHDRAWAL FORMS WITH GRADES

• TRANSCRIPT

• STANDARIZED TEST SCORES

• ESL BILINGUAL RECORDS FOR LEP STUDENTS (if applicable}

LPAC DOCUMENTS, PARENT PERMISSION LETTER, EXIT LETTER, PARENT DENIAL FORMS,

MONITOR ONSERVATION FORMS, TELPAS OR LANGUAGE TESTING, ORIGINAL HOME

LANGUAGE SURVEY, DOCUMENTATION SHOWING LIMITED ENGLISH PROFICIENCY

• SPECIAL EDUCATION AND 504 RECORDS {if applicable) - PLEASE FAX RECORDS TO

• MARIA PAVON AT 432-689-1044 OR CALL 432-240-1404

Midland ISD

Student Enrollment form / Tarjeta de Matricuta

(Please ?f\r\XIEscnha con letra de molde)

Student's Legal Name sameBirth Certificate

nombre leaal del estudiante

Last:

J^Hido Paterno:First:

Nombre:

Middle:

2ndo Nombre:

FOR OFFICE USE ONLY / PARA USO EXCLUSJVO DE ESTA OFICINA

Local ID #: TEA/PQMS ID #: Ctrl #: Big Code: School Year:

Entry Date: Campus: Teacher/Counselor: Sorted Alpha By

Bus #: Room #: Transfer Code: Withdrawal Date: Moving To:

STUDENTINFORMATION / INFORMAaONDEL ESTUDIANTE

Birth Date:

Fechade

Naclmlento:

Age:Edad:

Sex:

5e*io;

Grade:

Grado:

Please answer BOTH parts of the following questions on the student's ETHNICITY & RACE. For additional information,please refer to the Midland ISD website www.midlandisd.net click on the "Parent Links" button.

PART ONE

Student's ETHNICITY? (MUST select one) Hispanic/Latino//f/5pa/70/ia/7/70 Not Hispanic/Latino/NoMspa/ro/iafwro

PART TWO

Student's RACE? (MUST select one or more) American Indian or Alaska Native/ Indio Americano o Nativo de Alaska

AsxanfAsiab'co Black or African tmencsn!Negro 6 Americano Afh'cano

Native Hawaiian or Pacific Islander//Vaf/Vo de Hawai u Otras Islas del Padfico \Nh\telBlanco

Place of Birth/ Lugar de nacimiento:

Country of Birth: United States

Par's de Nacimiento: Estados Unldos

Other:

Otro:

If Other, how long have you resided in the US?

En caso de otro par's, icuanto b'ene residiendo en US?-

Street#

# de Calle

Street Name

Nombre de la Calle

Apt#

#Aot

CityCr'udad

State

Estado

ZipCddigo Postal

Mailing AddressDir. correso.

Home Address

Domlcilio Res.

Parent/Guardian

1

Padre/Tutor 1

First Hamej Nombre: MI//; Last Name//1/?e///yo; Relationship to Student:Parentezco cm Estudiante:

Date of Birth:

Fecha de Nacirrriento:

Street#/ / de Calle: Street Name jNombre de la Calle NgtHi^Apt: OkitQudad StaltelEstado Zv^j Cddigo Postal:

Home! rkTelefona Work Phone/ Trabajo: Cell Phone/# Celular: Employer/fi77/7/eactor;

How long at this address?cCuanto tiempo en esta direccion?

E-Mail PddressIdireccion de e-mail: Resides with Student:

Vive con estudiante: yes no

Parent/Guardian

2

Padre/Tutor 2

First Name//Vo/77/7/ie; MI//; Last Hame! Apellldo: Relationship to Student:Parentezco con Estudiante:

Date of Birth:

Fedra de Nadmiento:

Street#/ # de Calle: Street Name j Nombre de la Calle tvptH! FApt: OtflGudad StAejEstado Z\pl Codigo Postal:

Home! #Telefono: Work Phone/ Trabajo: Cell Phone/# Celular: Employer/577jD/e3Cfor;

How long at this address?cCuanto tiempo en esta direccion?

E-Mail Mdress!direccion de e-mail: Resides with Student:

//Ve con estudiante:yes no

PRIMARY EMERGENCY CONTACT (OTHER THAN PARENTS LISTED ABOVE)CONTACTOS DE EMERGENCZA (DUE NO SEAN LOS ARRIBA MENCIONADOS)

Name:

Nombre:

Phone #:

# Telefono:

Authorized to pick up from school?dSe le autoriza para recxiger al estudiante? yes no

ADDITIONAL EMERGENCY COmNCtS! CONTACTOS ADICIONALES DE EMERGENCIA

Name:

Nombre:

Phone #:

# Telefono:

Authorized to pick up from school?cSe le autoriza para recoger al estudiante? yes no

Name:

Nombre:

Phone #:

# Telefono:

Authorized to pick up from school?dSe le autoriza para rerxtger al ̂tudiante? yes no

Name:

Nombre:

Phone #:

# Telefono:

Authorized to pick up from school?cSe le autoriza para recoger al estudiante? yes no

Name:

Nombre:

Phone #:

# Telefono:

Authorized to pick up from school?cSe le autoriza para recoger al estudiante?

yes no

The above information is true to the best of my knowledge. / EsUt infbrmacion es verdadera de acuerdo a mi concoimiento.

Signature/F/rma; Date/Fec/ra;Please complete.re verse side/Favor de ttenar e! lado reverse

d I

APPmONAL INFORMATION / INFORMACION ADICIONAL

Name

Nombre

atyCiudad

State

Estado

Grade Level

# Grado

To Date

Hasta

To Date

Hasta

Last Sch<

Attended

Ultima

Escueia queAsistio

Last MISD

School

Attended

Ultima

escueia de

MISD queAsistio

Last Texas

School

Attended

Ultima

escueia de

TejasqueAsistio

BROTHERS ANP SISTERS ATTENP1N6 MIPLANP ISP SCHOOLS

HERMANOS(AS) QUE ASISTEN A LAS ESCUELAS DE MISD

Last Name

Ap^iido PatemoFirst Name

Nombre Primo

MI

I

School

Escueia

Grade

# Grado

Date of Birth

f^cha de Nacimiento

Month

Mes

DayOta

Year

Ano

HEALTH RELATEP INFORMATION / INFORMACIONSOBRE LA SALUD

Allergies or pertinent health information;Ale^ias 6 informacion sobre la salud de su hlio(a):

I give consent for Midland ISD to obtain emergency medical treatment for my child.mi consenb'miento para que MISD obtenga tratamiento medico de emergencia para mi hijo(a):

Signature/ Firma: Dat&i Fecha:

***FOR OFFICE USE ONLY***TEXAS PUBUC SCHOOL STUPENT ETHNICITY ANP RACE OBSERVER QUESTIONNAIRE***

The campus observer is to document any blank responses for Part 1 and/or Part 2, if the parent/guardian declined. ONLYanswer the part not answered by parent/guardian. United States Federal Register (71 FR 44866)This space reserved for Local school observer

Ethnicity - choose only one:

_ Hispanic / Latino

_ Not Hispanic/Latino

Race - choose one or more:

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhite

Observer signature: Date:

MIDLAND INDEPENDENT SCHOOL DISTRICT

HEALTH SERVICES DEPARTMENT

MISD Student Health Information Card

Today's Date:

Last Name (Apellido)

First Name (Primer Nombre)

Middle Name (Segundo Nombre)

Address (Recidencia)

Grade (Grade) Teacher (Maestro/a) ID#_

D.O.B. (Fecha de nacimiento) Age (Anos de edad)

Gender: M or F (Check one) (Sexo: Masculine o Femenino ) (marque uno)

Mother's Name (Nombre de la Madre)

Cell# (#de Celular) Work# (# de Trabajo)

Home# (# de la Casa) Email Address (Correo Electonico)

Father's Name (Nombre del Padre)

Cell# (#de Celular) Work# (# de Trabajo)

Home# (# de la Casa) Email Address (Correo Electonico)

Other Emergency Contact (Contacto de Emergencia)

Cell#(#de Celular) Relationship (Relacion)

Other Emergency Contact (Contacto de Emergencia)

Cell#(#de Celular) Relationship (Relacion)

How does student get home from school? [] Walks Home [] Parent Pick-up []Bus#

Medications taken at home/school (Medicamentos que toma en casa/escuela)

Allergies-Explain Reaction (medication,food, insect bites, etc.) (Alergias-Reaccion (medicamentos, comidas,

piquete de insectos, etc.)

[ jUses Epi-Pen

Asthma (Asma) [ iMild(Leve) [ JModerate (Moderado) [ JSevere (Grave)

[ ]Uses Inhaler (Utiliza inhalador) [ ]Uses Nebulizer (Utiliza Nebulizador)

Physician (Doctor) Phone # (# de Telephono)

Dentist (Dentista) Phone # (# de Telephono)

Orthodontist (Ortodontista) Phone # (# de Telephono)

[ JSeizure Disorder (Ataques) Type of Seizure (Tipo de ataques)

Date of last Seizure (fecha del ultimo ataque)

[]Diabetic (Diabetico) [ jType I (Tipo I) [ JType II (Tipo II) [] Insulin Pump (Utiliza una bomba de insulina)

Any Significant Health Issues or N/A (Otros problemas de salud significativos)

[ ]Wears Glasses (Usa Lentes) [ JWears Hearing Aids (Usa aparatos auditivos)

Parent/Guardian Signature (Firma de Padre/Madre/Tutor)

Rev. 03/30/17

MIDLAND INDEPENDENT SCHOOL DISTRICT

HEALTH SERVICES DEPARTMENT

AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION

This Authorization is provided in accordance with the Standards for Privacy of Individually Identifiable Health

Information (the ''Privacy Standards'') issued under the Health Insurance Portability and Accountability Act of 1996,

as amended {"HIPAA"), which went into effect April 2003.

"I, , am the parent/guardian of ,

the individual receiving treatment and I hereby authorize the use or disclosure of his/her protected health

information as described in this Authorization."

This dpcument authorizes that staff of (name of campus) to receive health information,

on a 'Ineed to know" basis, with the intent of providing consistent and quality health and care assistance, while in

attendance at this specific campus and field trips which has been parent authorized.j

The campus nurse can receive and send communication regarding any medical examination reports and

conclusions, to and/or from the student's healthcare provider, when such knowledge would impact the health care

of this student while attending school.

This specified information will be used for the purpose of providing appropriate health care for this student,

classroom modification, other campus activities and emergency response.

Right to Revoke: "I understand that I have the right to revoke this Authorization at any time by notifying the

school, in writing, and I understand that revocation is only effective after it is received and logged by campus nurse

or authorized designee."

"I understand that I cannot revoke this Authorization to the extent that the school has taken action in reliance of

this Authorization."

"I understand that this Authorization is not required for Midland ISD to use or disclose this information for purposes

of treatment, or if the use or disclosure is otherwise permitted by the Privacy Standards, and that any revocation of

this Authorization will have no effect on such uses or disclosures."

"I understand that I am entitled to receive a copy of this Authorization."

"I understand that this Release of Information Form can be reviewed in 6 months."

Date Parent/Guardian Signature

Rev. 03/30/17

fC il ti c a 11 n thf F ii l u

Midland ISD Form-a

Division of Teaching and Learning

Bilingual/ESL Department— Home Language Survey

Midliind lndep«?ndfnl Schi-4 iii.-trii-.

TO BE COMPLETED BY PARENT OR GUARDIAN (OR STUDENT IF GRADES 9-12): The state of Texas requires that the

following information be completed for each student that enrolls for the first time in Texas public schools. This survey

shall be kept in each student's permanent record folder.

NAME OF STUDENT STUDENT ID#

ADDRESS ^TELEPHONE #

CAMPUS

Grade

1. What language Is spoken In your home most of the time?

2. What language does your child speak most of the time?

(If you are in grades 9 -12 and are filling this out for yourself, what language do you speak most of the time?)

Signature of Parent/Guardian Date

Signature of Student (Grades 9-12) Date

Do Not Cut(Spanish version)DEBE DE COMPLETARSE PGR EL PADRE/MADRE/ O REPRESENTANTE LEGAL: (0 PGR EL ESTUDIANTE SI ESTA EN LGSGRADGS 9-12): El estado de Texas requiere que la siguiente informacibn se complete para cada estudiante que se

matricula por primera vez en una escuela publica de Texas. Este cuestionario se archivara en el expediente delestudiante.

NOMBRE DEL ESTUDIANTE #ID

DIRECCION TELEFONO.

ESCUELA

Grade

1. dQue idioma se habia en su hogar la mayoria del tiempo?

2. dClue idioma habia su hijo/a la mayoria del tiempo?

[dSi estis en los grados del 9 -12 y estas llenando esta forma para ti mismo, que idioma hablas la mayoria del tiempo?)

Firma del Padre/Madre/ o Representante Legal Fecha

Firma del estudiante si esta en los grados 9-12 Fecha

Midland ISD • ELL Department • Revised May 2015

Form # 2542

Midland ISD

Division of Teaching and Learning

Bilingual/ESL Department - Home Language Survey■Midkintl InciependetiL 5^ht<(i| DUinct

{Chin version)Nu le pa or kilkhawl tu in ngan ding (or 9-12 mi na site): Texas state Public School daanvek Innau hak tiawng a lut tu in a hnuai ih thula sut mi pawl pek a tul. Hi thu suh tawi cu tiawngta ih hminsin (record) kumkhua a si ding.

Tiawngta timing ^Tiawngta ID#

Address ^Teleptione

Tiawng inn (campus)

Pliun zlat (grade)

1. Inn ah ziangmi tong nan hman tarn bik?

2. Nan fa le in ziang tong (nan hman) hman bik ?

Nu le Pa /Kilkhawl tu hmin thut Nithia

Phun 9-12 tiawngta hmin thut Nithia

Do Not Cut(Vietnamese version)Se hoan thanh vac phu huynh (OR HOC SINH NEU LOP 9-12): lieu bang Texas yeu cau cacthong tin sau day du'Q'c hoan thanh cho moi hoc sinh ma tuyen sinh Ian dau tien trong cac trtrbng cong lap cr TexasCupc khao sat nay duac luu giu* trong thir muc ho so vTnh vien cua moi hoc sinh.

TEN HOC SINH HOC SINH ID #OlACHi OIENTHOAI#Tru-crng (campus).

Hoc lo^p (grade)

1. Ngon ngu' nao dirofc noi 6" nha cua ban hau het thdi gian?

2. Ngon ngu* nhO'ng g] con ban noi hau het thcxi gian?

Chu' ky cua phu huynh / ngtroi giam ho Ngay

ChO ky cua hoc sinh (Hoc I6p 9-12) Ngay

Midland ISD • ELL Department • May 2015Form # 2542

student Residency Questionnaire School Name:.

The information on this form is required to meet the law known as the McKlnney-Vento Act 42 U.S.C. 11434a{2), Sec.722. of theEvery Student Succeeds Act. The answers you give will help the school determine the services the student may be eligible to receive.Presenting a false record orfalsifying records is an offense under Section 37.10, Penal code, and enrollment of the child under false

documents subjects the person to liability for tuition or other costs. TEC Sec. 25.002(3)(d).

Name of Student: Gender: QMale □ FemaleLast First Middle

Birth Date: / / Grade: Student ID#:Month / Day/Year

Check the box that best describes with whom the student resides. {Please note: legal guardianship may be granted onlyby a court; students living on their own or with friends or relatives who do not have legal guardianship are allowed toenroll In and attend school. The school cannot require proof of guardianship for enrollment or continued attendance.)

□ Parent(s)□ Legal Guardians(s)□ Caregiver(s) who are not legal guardlan(s} (Examples: friends, relatives, parents of friends, etc.)□ Student Is currently in Foster Care, under Managing Conservatorship of the Texas Department of Family and

Protective Services (DFPS).□ Other

Name of person with whom student resides:Address:City: ZIP:Home Phone #: Cell Phone #: Other Emergency #:Length of Time at Present Address:

Please check only one box that best describes where the student is presently living:□ In my own home or apartment. Check the box(s) that describe your home. (Code 0)

□ My home has running water and electricity (Code 0)□ My home has no electricity (Code 3)□ My home has no running water (Code 3)

□ In the home of a friend or relative because I lost my housing (examples: fire, flood, lost job, divorce, domesticviolence, kicked out by parents, parent in military and was deployed, parent(s) in jail, etc.) (Code 2)

□ Unaccompanied Minor (Code 4)□ In a shelter because I do not have permanent housing (examples: living in a family shelter, domestic violence

shelter, children/youth shelter, FEMA housing) (Code 1)□ In transitional housing {housing that is available for a specific length of time only and is partly or completely

paid for by a church, a nonprofit organization, or another organization) (Code 1)□ In a hotel or motel (examples: because of economic hardship, eviction, cannot get deposits for permanent

home, flood, fire, hurricane, etc.) (Code 4)□ In a tent, car, van, abandoned building, on the streets, at a campground, in the park, or other unsheltered

Location (Code 3)□ None of the above describe my present living situation.

1 I P a g eRevised Apri l 2016

student Residency Questionnaire School Name:

Factors contributing to the student's current living situation (check all that apply):

□ Natural disaster

□ Tornado, storm, flood, etc.□ Hurricane, name:□ Fire: prairie, forest, grass, lightning strike, etc.

□ Family issues such as divorce, domestic violence, kicked out by parents, student left due to family conflict, etc.□ Home issues such as lack of electricity, water, heat, adequate home repair due to lack of funds, overcrowding,

mold, etc.□ Military: Parent/guardian deployed, injured or killed in action□ Incarceration of parent/guardian□ Incapacitation of parent or guardian due to health, mental health, drugs/alcohol, or other factors□ Home fire not due to natural causes (i.e., faulty equipment/appliances/wiring, furnace, stove, fireplace, etc.)□ Economic hardship:

□ Loss of job resulting in inability to pay rent or mortgage□ Income from part-time or low paying job does not cover cost of housing in the area□ Loss of housing

□ High medical bills that leave little or no money for housing□ Lack of affordable housing in the areaQ Minor student unable to afford housing on my own□ None of the above

Please provide the following information for school-age siblings (brothers and/or sisters) of the student:

Name Grade Level Name of School

Signature of Parent/Legal Guardian/Caregiver/Unaccompanied Student Date

For School Use Only□ I certify the above named student qualifies for services of the McKinney-Vento Act.□ I certify the above named student does not qualify for services of the McKinney-Vento Act.

McKinney-Vento Liaison Signature Date

2 I P a g eRevised Apr i l 2016

NOTICE TO PARENTS Release of Information

Midland ISD is required by law to provide you with the following notice:

Certain Information about District students Is considered directory Information and

will be released to anyone who follows the procedures for requesting the Informationunless the parent or guardian objects to the release of the directory Information aboutthe student. If parents do not want Midland ISD to disclose directory informationfrom their child's education record without your prior written consent, you must

notify the District In writing within ten school days of your child's first day ofInstruction for the current school year.

This means that the District must give certain personal information (called "directoryinformation") about your child to any person who requests it, unless you have told the District

in writing not to do so.

You also has the right to tell the District that it may not use directory information about yourchild for school-sponsored purposes, such as school newspapers, yearbooks, recognitionactivities and notices, honor rolls, media releases and athletic programs. (Directory informationpermitted for limited school-sponsored purposes remains otherwise confidential and will notbe released to the public if you object to such release.)

In addition, federal law requires that the District release information concerning secondary

students to military recruiters and institutions of higher education, upon request, unless theparent or eligible student directs the District no to release information to these types ofrequestors without prior written consent.

The District is providing you with the accompanying form so you can communicate your wishesabout these issues.

Midland ISD has designated the following student information as directory

information for School-Sponsored Purposes:

For the following school-sponsored purposes—all District publications and announcements-directory information shall include student name, address, photograph, date of birth, majorfield of study, honors and awards, dates of attendance, grade level, enrollment status,participation in officially recognized activities and sports, and weight and height of members ofathletic teams.

Midland ISD has designated the following student information as directoryinformation for All Other Purposes (including military recruiters andinstitutions of higher education):

For all other purposes, directory information shall include student name, address, major field ofstudy, honors and awards, dates of attendance, grade level, enrollment status, participation inofficially recognized activities and sports, and weight and height of members of athletic teams.

DIRECTORY INFORMATION RELEASE FORM

School

Student's Name

Student's #ID Number

Please indicate on the form below if you DO NOT give the District permission to release directoryinformation about your child in the specified categories. Please retum this form to your child's campus no

th

later than the 10 school day after the first day of school if you have noted objections. If you do not haveany objections to the release of your child's directory information, you do not need to retum this form.

DO NOT release my child's directory information to the public. (The "public" doesnot include school-sponsored purposes, military recruiters or institutions of highereducation.)

DO NOT release my child's directory information to military recruiters andinstitutions of higher education without my prior consent.

DO NOT release my child's directory information for school-sponsored purposes asdescribed in the accompanying notice to parents.

Parent/Guardian Signature

Date

VIDEOTAPING AND AUDIOTAPING OF STUDENTS

The Texas Education Code requires that schools obtain permission from parents/guardians before theschool may make or authorize the making of a videotape of a child or recording of a child's voice exceptin the following circumstances: (1) maintaining safety or discipline; (2) as part of regular classroominstruction; (3) as part of co-curricular or extracurricular activities; or(4) media coverage of the school. Midland Independent School District staff members are dedicated toproviding all students with a safe, undisrupted school environment. At no time will they allow the use ofvideo cameras or tape recorders to disrupt the educational program.

There are times during which Midland ISD would like to allow the use of a video camera or audiorecorders in the schools. Such instances may include but are not limited to the following:• to record the history and events of the school by members of the staff for use at school

assemblies, registration or as part of an informational videotape about the school,• to allow parents to videotape their child coming to school on the first day or participating in a

class birthday party or similar event for home use, or• to allow electronic news media such as television and radio stations to cover important issues

pertaining to the schools or school events of interest to the public for use on news broadcasts.

NOTE TO PARENT/GUARDIAN: Check your preference concerning videotaping and audio taping ofyour child. It is important that you check one response. Failure to return this form to the Administratorwill be viewed as your authorization to videotape and audiotape your child.

□I I YES, I give MISD permission to make or authorize the making of videotape or audiotaperecording of my child.

I In(I INQ. I do not give MISD permission to make or authorize the making of videotape or audiotaperecordings of my child.

Student Name:

School:

Grade:

Signature of Parent or Guardian:

Date of Signature:

Acknowledgment of Electronic Distribution of Student Handbook

My child and I have been offered the option to receive a paper copy or to electronically access atmidlandisd.net, the Midland Independent School District Parent and Student Handbook and theStudent Code of Conduct for 2017-2018.

I have chosen to:

□ Receive a paper copy of the Parent and Student Handbook and the Student Code ofConduct.

□ Accept responsibility for accessing the Parent and Student Handbook and Student Code ofConduct by visiting the Web address listed above.

I understand that the handbook contains information that my child and I may need during the school yearand that all students will be held accountable for their behavior and will be subject to the disciplinaryconsequences outlined in the Student Code of Conduct. If I have any questions regarding this handbookor the Code, I should direct those questions to the principal. For campus phone numbers, please call 432-240-1000.

Printed name of student:

Signature of student:

Signature of parent:

Midland ISD

Network Acceptable Use Policy

Midland ISD is providing students, staff, volunteers, and board members access to the district'selectronic network. This network includes Internet access, computer services, videoconferencing,computer equipment and related equipment for educational purposes. This document contains the rulesand procedures for acceptable use of the Midland ISD electronic network. Where the term "user^appears, the policy applies to any network user. Where the term "student" appears, that aspect appliesonly to students.

• The Midland ISD electronic network has been established for a limited educational purpose. The term

"educational purpose" includes classroom activities, career development, and limited high-quality self-discovery activities.

• The Midland ISD electronic network has not been established as a public access service or a publicforum. Midland ISD has the right to place reasonable restrictions on material that is accessed or postedthroughout the network. Parent/guardian permission is required for all students under the age of 18.• Access is a privilege — not a right. Students, parents, and teachers sign a form every school year(part of the registration packet) indicating familiarity with the acceptable use policy.

• It is presumed that users will honor this agreement they and/or their parent/guardians have signed.The district is not responsible for the actions of users who violate them beyond the clarification ofstandards outlined in this policy.

• The district reserves the right to monitor all activity on this electronic network. Users will indemnify thedistrict for any damage that is caused by users' Inappropriate use of the network.• Users are expected to follow the same rules, good manners and common sense guidelines that areused with other daily school activities as well as the law In the use of the Midland ISD electronicnetwork.

General Unacceptable Behavior

While utilizing any portion of the Midland ISD electronic network, unacceptable behaviors include, butare not limited to, the following:

Network users will not post information that could cause damage or danger of disruption.

• Engaging in personal attacks, including prejudicial or discriminatory attacks.

• Harassing another person. Harassment is persistently acting in a manner that distresses or annoys

another person. If a user is told by a person to stop sending messages, they must stop.• Knowingly or recklessly posting false or defamatory information about a person or organization.• Unauthorized disclosure, use, or dissemination of personal information regarding minors.• Using criminal speech or speech in the course of committing a crime such as threats to the president,instructions on breaking into computer networks, child pomography, drug dealing, purchase of alcohol,gang activities, threats to an individual, etc.

• Using speech that is inappropriate in an educational setting or violates district rules.• Abusing network resources such as sending chain letters or "spamming".

• Displaying, accessing or sending offensive messages or pictures.

• Using the Midland ISD electronic network for commercial purposes, or offering, providing, orpurchasing products or services through this network.

• The Midland ISD electronic network will not be used for political lobbying.

• Network Users will not attempt to access non-instructional district systems, such as studentinformation systems or business systems, without authorization.

• Users will not connect any networkable device (either wired or wireless) to the MISD network withoutauthorization. Example: The use of a computer or device brought from home accessing the network inany way not designated as "guest access."

• Users will not attempt to circumvent web filtering through proxies or other means.• Users will not use district equipment, network, or credentials to threaten other users, or cause a

disruption to the educational program.• Users will not use the district equipment, network, or credentials to send or post electronic messagesthat are abusive, obscene, sexually oriented, threatening, harassing, damaging to another's reputation,or illegal.

• Per TEC Sec. 26.009, students should not use devices (either personal or district provided) to takephotos or videos of other students or staff. Students may only use devices for approved classroomInstructional use.

E-Mail and Electronic Posting

• E-mail accounts are not generally being provided for students, though there may be exceptions madein special cases. However, there are internal messaging options (blogs, etc.) on the classroom websitewhich allow students to communicate. Students may not utilize any E-mail system or Chat Room from adistrict computer without approval or monitoring by school personnel.• Web-based e-mail accounts may be restricted or blocked at the discretion of the network

administrator, to protect the network from viruses, spam, or bandwidth abuse.• Students will not establish or access Web-based e-mail accounts on commercial services through thedistrict network unless such accounts have been approved for use by the district.• Users will not repost a message that was sent to them privately without the permission of the personwho sent them the message.• Users will not post private information about another person.• Users are prohibited from sending sensitive information via E-mail. (e.g. full student name, ID number,social security number, date of birth, username, and password)

Midland ISD Website

• Classroom websites and opportunities to share information and comments by students are nowavailable. These websites are managed by the teachers.• Content, access and available features of the website will differ for members of the public, comparedto district users.

• Classroom teachers are responsible for the content on their classroom web pages.• Principals and departmental supervisors are responsible for the content on their sections of theMidland ISD web site and taking any corrective action.• Students' responsibilities when posting on the classroom web pages are to be explained by theteacher.

World Wide Web

• All Internet content available to Midland ISD users is filtered through a category-based appliance tocomply with the Children's Internet Protection Act of 2001 (C.I.P.A.) The list of inappropriate web sitesis constantly updated through a subscription. However, no guarantee can be made that the system will

be 100% accurate. It is ultimately the responsibility of the instructor in the classroom to monitorappropriateness of the web sites viewed.

Personal Safety

• Students will not share personal contact information about themselves or other people. Personalcontact information includes address, telephone, school address, or work address.• Elementary and middle school students will not disclose their full name or any other personal contactinformation for any purpose.

• High school students will not disclose personal contact information, except to education institutes foreducational purposes, companies or other entities for career development purposes, or without specificbuilding administrative approval.

• Students will not agree to meet with someone they have met online.

• Students will promptly disclose to a teacher or other school employee any message received that isinappropriate or makes the student feel uncomfortable

• Students will be provided access to information, through their instructors, regarding appropriate safetyguidelines for online behavior, pertaining to social networking sites, chat rooms, and "cyber bullying".

System Security

• Computer users are responsible for their individual accounts and should take all reasonableprecautions to prevent others from being able to use them. Computer users should not provide theirpassword to another person.

• Users must immediately notify a teacher or the system administrator if they have identified a possiblesecurity problem. Computer users should not go looking for security problems, because this may beconstrued as an illegal attempt to gain access.

• Users will not attempt to gain unauthorized access to any portion of the Midland ISO electronicnetwork. This includes attempting to log in through another person's account or access anotherperson's folders, work, or files. These actions are illegal, even if only for the purposes of "browsing".• Users will not make deliberate attempts to disrupt the computer system or destroy data by spreadingcomputer viruses or by any other means. These actions are illegal.• Computer users will not attempt to access Web sites blocked by district policy, including the use ofproxy services, software, or Web sites.

• Computer users will not use sniffing or remote access technology to monitor the network or otheruser's activity.

Software and Files

• Software is available to users to be used as an educational resource. No user may install, upload or

download software without permission from the district technology department. District software isapproved according to guidelines available at; www.midlandisd.net/software_guidelines.• A user's account may be limited or terminated if a user intentionally misuses software on any district-owned equipment.

• Files stored on the MISD network or district-sanctioned Internet (cloud-based) accounts are treated inthe same manner as other school storage areas, such as lockers. Routine maintenance and monitoringof the Midland ISO network and district-owned services may lead to discovery that a user has

violated network policy, Internet safety policy, or the law. Users should not expect that files stored ondistrict servers are private.

• When storing or sharing sensitive information, users must utilize approved network storage devicesand applications.

• The information stored on external storage devices (i.e. a USB drive) utilized with district computerswill be encrypted.

Technology Hardware

• Hardware and peripherals are provided as tools to users for educational purposes. Users are

not permitted to relocate hardware (except for portable devices), install peripherals or modifysettings to equipment without the consent of the district technology department.

• The school district may permit the use of personally-owned computing devices on its network, at

the discretion of teachers and administrators. All "guest" users must acknowledge receipt andunderstanding of administrative regulations governing the use of the district's technologyresources and agree to allow monitoring of their usage and to comply with the regulations. Non-

compliance may result in suspension of access or termination of privileges and otherdisciplinary actions consistent with district policies.

Vandalism

• Any malicious attempt to harm or destroy data, the network, other network components connected to

the network backbone, hardware or software will result in cancellation of network privileges. Disciplinarymeasures in compliance with the district's discipline code and policies will be enforced.

Plagiarism and Copyright Infringement

• Users will not plagiarize works found on the Intemet. Plagiarism is taking the ideas or writings ofothers and presenting them as if they are one's own.• District policies on copyright will govern the use of material accessed and used through the districtsystem.

• Copyrighted material will not be placed on any system without the author's permission. Permissionmay be specified in the document, on the system or must be obtained directly from the author.

Student Rights

• Students' right to free speech applies to communication on the Internet. The Midland ISD electronicnetwork is considered a limited forum, similar to the school newspaper, and therefore the district mayrestrict a student's speech for valid educational reasons. The district will not restrict a student's speechon the basis of a disagreement with the opinions that are being expressed.• An individual search will be conducted if there is reasonable suspicion that a student has violated thispolicy or the law. The investigation will be reasonable and related to the suspected violation.

Due Process

• The district will cooperate fully with local, state, or federal officials in any investigation related to anyillegal activities conducted through the district network.

• In the event there is an allegation that a user has violated the district's acceptable use regulations andpolicy, the user will be provided with a written notice of the alleged violation. An opportunity will beprovided to present an explanation before a neutral administrator (or user will be provided with noticeand an opportunity to be heard in the manner set forth in the disciplinary code).

• Disciplinary actions will be tailored to meet specific concems related to the violation and to assist thestudent in gaining the self-discipline necessary to behave appropriately on an electronic network.• Violations of the acceptable use regulation and policy may result in a loss of access as well as otherdisciplinary or legal action.

• If the violation also involves a violation of other provisions of other schooi rules, it will be handled in amanner described in the school rules. Additional restrictions may be placed on a user's use of his/hernetwork account.

Limitation of Liabiiity

• The district makes no guarantee that the functions or the services provided by or through the districtnetwork will be error-free or without defect. The district will not be responsible for any damage suffered,including but not limited to, loss of data, functionality, or interruptions of service, caused by connectinga device to its network.

• The district is not responsible for the accuracy or quality of the information obtained through or storedon the network. The district will not be responsible for financial obligations arising through theunauthorized use of the network.

Violations of this Acceptable Use Policy

Violations of this policy may result in loss of access as well as other disciplinary or legal action. Users'violation of this policy shall be subject to the consequences as indicated within this policy as weil asother appropriate discipline, which includes but is not limited to:

•Use of district network only under direct supervision

•Suspension of network privileges•Revocation of network privileges

•Suspension of computer privileges•Suspension from school

•Expulsion from school and/or

•Legal action and prosecution by the authorities

The particular consequences for violations of this policy shall be determined by the schooladministrators. The superintendent or designee and the board shall determine when school expulsionand/or legal action or actions by the authorities are the appropriate course of action.

STUDENT

I understand and will abide by the Network Acceptable Use Agreement, which may be found athttp://www.midlandisd.net/network-policy and the student responsibilities above. I further understand that anyviolation of the regulations therein is unethical and may constitute a criminal offense. Should I commit any violation,my access privileges may be revoked, school disciplinary actions may be taken, and/or appropriate legal actionmay be initiated.

Student Name (please print): ID #:

Signature: Date:

PARENT OR GUARDIAN

As the parent or guardian of this student, I have read the Network Acceptable Use Agreement. I understand thatthis access is designed for educational purposes. Midland ISD has taken precautions to eliminate controversialmaterial. However, I also recognize it is impossible for Midland ISD to restrict access to all controversial materialsand I will not hold them responsible for materials acquired on the network. Further, I accept full responsibility forsupervision if and when my child's use is not in the school setting. I hereby give permission to issue an account formy child and certify that ̂ e information contained in this form is correct. I understand that without my writtenpermission, my child will not have Intemet access.

Parent of Guardian's Name (please print):

Signature: Date:

SPONSORING TEACHER/LIBRARIAN (must be signed if the applicant is a student)

I have read the Network Acceptable Use Agreement and agree to promote this agreement with the student.Because the student may use the network for individual work or in the context of another class, I cannot be heldresponsible for the student use of the network. As the sponsoring teacher I have discussed with the studentacceptable use of the network and the proper network etiquette.

Teacher's Name (please print):

Signature: Date:

MISD EMPLOYEeeOARD MEMBER/PARENTA/OLUNTEER

I understand and will abide by the above Network Acceptable Use Agreement. I further understand that any violationof the regulations therein is unethical and may constitute a criminal offense. Should I commit any violation, myaccess privileges may be revoked, employee disciplinary actions may be taken, and/or appropriate legal action.

MISD Employee/Board Member/Parent/Volunteer Name (please print):

Signature:

Date:

STUDENTS MUST ATTEND SCHOOL EVERYDAY...

IT'S THE LAW!Unless specifically exempted by Section 25.086 a child who is at least six years of age, or who is younger than six years ofage and has previously been enrolled in the first grade, and who has not yet reached the child's IP*** birthday shall attendschool.

-WHEN IS A STUDENT IN VIOLATION OF THE COMPULSORY ATTENDANCE LAW?

A student who has 10 unexcused absences or parts of day violations in a 6 month time period is determined to be inviolation of the Compulsory Attendance Law.

-WHAT HAPPENS IF A STUDENT/PARENT ARE IN VIOLATION OF THE COMPULSORY ATTENDANCE LAW?

Parents are subject to a trial in a Civil Court for contributing to non-attendance:* If their student has 10 or more days of unexcused absences within a 6-month period,* This includes "parts of days"; arriving late to school or leaving early from school without valid excuse.

Secondary students are also subject to a trial in a Civil Court if they have:* 10 or more days of unexcused absences within a 6-month period,* This includes "parts of days"; arriving late to school or leaving early from school without valid excuse.

-WHAT IS AN UNEXCUSED ABSENCE?

An unexcused absence is an absence that does not fall within the state or district guidelines (see excused absences below).An unexcused absences also occurs when the parent cannot produce any document that explains the absence or they presentdocumentation that does not meet district criteria.

-WHAT IS A VERIFIED OR 'EXCUSED' ABSENCE?

The following are approved district absences (if documented):* Religious Holy Days * Required court appearances* Activities related to obtaining U.S. Citizenship * Serving as an election clerk* Health-Care appointments * Mental-Health or Therapy appointments* Students in Conservatorship of DFPS * Court-Ordered family visitations

In addition, a junior or senior student's absence of up to two days related to visiting a college or university will beconsidered an exemption, provided the student receives approval from the campus principal, follows the campus proceduresto verify such a visit and makes up any work missed.

Absences of up to two days in a school year will also be considered an exemption for a student serving as an early votingclerk, provided the student notifies his or her teachers and receives approval from the principal prior to the absences.

As listed at Accommodations for Children of Military Families, Absences of up to five days will be excused for a student tovisit with a parent, stepparent, or legal guardian who has been called for duty for, is on leave from or immediately returnedfrom certain deployments.

FOR ADDITIONAL INFO, CALL MIDLAND ISD'S ATTENDANCE OFFICE:

(432)240-1520 or FAX (432) 689-5033

Compulsory Attendance and Acknowledgement2017-2018

DEPARTMENT OF STUDENT SERVICES

615 W Missouri Avenue STE: 403

Midland, Texas, 79701-5017

Teresa Moore-Executive Director

Tony De La Rosa-Supervisor Student Attendance

(432) 240-1520 FAX (432) 689-5033

Student's Legal Name:

Student ID Number: Social Security Number

(Middle)

Please sign the acknowledgment form below, and return the signed original to your child's school. If you have any

questions, you may contact the school your child is attending.

Acknowledgement

I have received information governing Compulsory Attendance. My signature is only an acknowledgement that I havereceived this notice.

Name of Parenl/ZGuardian (Please Print):

Student Name ID Number

Military Connected Student

Not a military connected Student

Student Is a dependent of an ACTIVE DUTY member of the United States military (Army, Navy, Air

Force, Marine Corps or Coast Guard)

Student Is a dependent of a member of the Texas National Guard (Army, Air Guard, or State

Guard)

Student Is a dependent of a member of a reserve force In the United States military (Army, Navy,

Marine Corps, Coast Guard)

PRE-KINDERGARTEN STUDENT Is a dependent of: 1) an ACTIVE DUTY uniformed member of the U.S.

military (Army, Navy, Air Force, Marine Corps, or Coast Guard), 2) an ACTIVATED/MOBILIZED

uniformed member of the Texas National Guard (Army, Air Guard, or State Guard), or 3) an

ACTIVATED/MOBILIZED member of the U.S. reserve (Army, Navy, Marine Corps, Air Force, or Coast

Guard), or 4) member of U.S. military or reserve orTX National Guard who was Injured or killed while

serving on active duty.

Parent Signature Date

Vl.O

MIDLAND ISD

MIGRANT ED UCATION PROGRAM

FAMILY SURVEY

Dear Parents,

In order to better serve your children, our school district is helping the State of Texas identifystudents who may qualify to receive additional educational services.The information below will be kept confidential.Please answer the following questions and click the "Save Changes" button below to return thisform to your child's school.

1. Within the past 3 years have you, or vour child, moved from one school district, city orstate to another?

2. If yes, did you, or your child, move so you could work or look for work in agriculture orfishing?If your answer above is NO, STOP here and click Save Changes below to submit form.

If your answer is YES, please check all that apply below.

Working in fhiit, vegetable, sunflower, cotton, wheat, grain, farms orranches, fields and vineyards

Working in a cannery

Working on a dairy farm

Working in a fishery

Working on a poultry farm

Working in a plant nursery, orchard, tree growing or harvesting

Working in a slaughter house

Other similar work, please explain:

Please complete the followinginformation:

Best time to contact you:

Parent/Guardian Name:

Home Address/Apt Name:

Mailing Address:

TelephoneNumber:

Zip Code:

Zip Code:

COMPLETE THIS FORM FOR ALL

STUDENTS REGARDLESS OF SPECIAL

EDUCATION STATUS

MIDLAND ISD

STA TEMENT OF SPECIAL EDUCA TION SER VICES

NAME OF STUDENT: DOB: GRADE:

School Attending:

1. The above named student has NEVER received special education services.

If you answered TRUE, DO NOT complete the rest of the form. Sign and return it to the yourchild's campus.

If you answered FALSE, proceed to Question 2, complete the rest of the form and return it toyour child's campus.

2. The above named student WAS RECEIVING special education services at his/her priorschool.

If you answered TRUE, complete the remainder of the form below.

This form serves as a release of information authorization in order to request your child's specialeducation records.

Please work with the campus Admission Review Dismissal (ARD) committee to assist inidentifying services to support your child.

Disabling conditions(s): (LD, ED, 01, MR, etc.)

Services received at previous school Check all that apply:

^ SpeechSelf Contained

^ Auditory Impaired (hearing)^ CMC

Visually Impaired

Other services:

3. The above named student received special education services in the past, BUT WASDISMISSED PER ARD COMMITTEE.

If you answered TRUE, enter year dismissed:

4. Comments:

Name and address of previous school:

HISTORY OF SCHOOL ATTENDANCE

HISTORIAL DEASISTENCIA ESCOLAR

Name

Nombre

City

Ciudad

State

Estado

Grade level

# Grado

From Date

Hasta

To Date

Hasta

Last School

Attended

Oltima Escuela

que

Asistio

Last MISD

School

Attended

Ultima Escuela

de MISD que

Asistio

Last Texas

School

Attended

Oltima Escuela

de Tejas que

Asistid

BROTHERS AND SISTERS ATTENDING MIDLAND ISD

SCHOOLS /HERMANOS(AS) QUEASISTEN A LAS ESCUELASDE MIDLAND ISD

Last Name

Apellido Paterno

First Name

Nombre Primo

Ml

1

School

Escuela

Grade

U Grado

Date of Birth

Fecha de Nacimiento

Month

Mes

Day

Dia

Year

Ano