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Dawson ISD Jr. & Sr. High

Teacher Handbook

2016-2017

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TABLE OF CONTENTS Bell Schedule 3-4 Calendar 5 PDAS Appraisal Calendar 6 Introduction, Mission, Goals, Announcements 7 Attendance 8 Student Support, Classroom, Clinic 9 Medication, Policies, Communication , Maint. & Trans. Request 10 Advisory Squad, Copy Room, Counseling 11 Faculty Dress Code 12 Drill, Hall Pass, Lesson Plans, Liability 13 Security, Fundraising, Movie Request, Tutoring, D-Hall, Zap 14 Student Tardy Guidelines and Procedures 15 Classroom Discipline Procedures 16 Teacher Evaluations, Tobacco Use, Grading Policy 17 Cont. Grading Policy 18

FORMS: Announcements 19 Attendance Corrections 20 Movie Request 21 Lesson Plans (Online) 22 Discipline Documentation 23 Teacher D-Hall 24 Grade Change 25 Discipline Slip 26 Grade Book Instructions 27 District Calendar 28 Student Tardy Slip 29 Ipad APP request 30 Transportation request (online) 31 Extra Duty 32 Faculty Sponsors 33 Student Activity 34 State Tax Exemption 35 Request Personal Leave 36 Fund Raising 37 Zap Detention 38 Common Discipline Issues & Actions 39

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2016-2017 Dawson ISD Calendar

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T-TESS APPRAISAL CALENDER

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INTRODUCTION

The purpose of the Dawson ISD High School Teacher Handbook is to provide an

overview of the essential policies, procedures, protocols, and general information in

order to facilitate a successful school year for all stakeholders. This document does

not include all district policies or procedures, and those included herein are

summarized.

This handbook is neither a contract nor a substitute for the official Dawson ISD

policy manual. It is not intended to alter the status of at-will employees. It is rather

intended to serve as a guide and brief explanation; for more detailed information,

employees should refer to the Dawson ISD Board Policy Manual available on campus

during regular working hours.

MISSION STATEMENT

The mission of DISD is to provide each student a meaningful, challenging education,

delivered in a safe learning environment that prepares him or her to be a capable,

productive, and contributing citizen.

DAWSON JR. & SR. HIGH SCHOOL GOALS

Create a safe learning environment

Raise Academic Success of our students

Create a welcoming campus for Parents and Community Members

Make sure all students are connected to something or someone on campus

Reduce discipline with firm and consistent actions

ANNOUNCEMENTS

High School announcements are made over the public address system located in the front office.

Most of the announcements will be made at the beginning of 2nd

period of each school day; these

general information or daily announcements must be submitted on the proper form with a teacher’s

signature to the High School Receptionist on the day before they are to be announced.

Announcements made during the school day must have Principal’s permission before being

conducted, please note that interruptions of class will only be for special circumstances.

Emergency announcements may be made at any time during the school day at the discretion of

Dawson ISD Administration.

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ATTENDANCE OF STUDENTS

A student must be given the opportunity to make up work due to any absence. Students

will be allowed a minimum of 3 days to make up assignments.

Please keep the office informed of students’ consecutive and/or excessive absences in your

class.

Parents will be notified by mail when their student has accumulated excessive absences

during a semester (3 or more).

Students 10 or more unexcused absences in a 6 month period will face truancy charges

against them.

A teacher may not permit a student to leave the campus for any reason without official

permission from the parent and proper authorization through the principal’s office.

A teacher may not request a student be released from another class for any reason other than

approved field trips. Fund raising, performance practice, etc., are not appropriate release

activities.

ATTENDANCE OF TEACHERS

Students are potentially denied valuable instructional learning on any occasion that requires

a substitute teacher, regardless of the substitute’s qualifications. Research indicates that in

the education of public school students there are but a few things as significant as continuity

to student success. Therefore, please make every effort to be here every day. In the event of

illness, emergency, or personal business, it is initially the teacher’s responsibility to ensure

that classes are covered appropriately.

Information readily available for substitute teachers should include daily attendance rolls,

schedule of classes, special duties, fire drill instructions, seating charts,

accommodations/modifications for students with special needs, lesson plans, etc.; it is the

regular teacher’s responsibility to prepare a folder that contains this information for

substitute teachers.

Teachers who are unable to attend school as a result of illness must inform Linda

Matthews, 903.879.5116, by 7:30 am on the day of illness; furthermore, teachers out ill

should phone in their status for the following day by 2:30 p.m. on the day of illness.

Failure to report either anticipated return to duty or additional leave status will result in the

retention of a substitute teacher for the following day.

Teachers who may need to leave their duties prior to the end of a given school day due to an

emergency must arrange to have their remaining classes covered through the High School

Principal. I will cover for you up to 90 minutes if you need to leave campus.

All teachers should be on campus by 7:30 am (7:20 A.M. IF ON DUTY) and remain on

campus until 3:45 p.m. each day unless other appropriate arrangements have been made with

administration.

Please make the principals aware of any situation for which you may need to leave

campus.

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CHILD ABUSE/WELFARE REPORT

A person who has cause to believe that a child’s physical or mental health or welfare has

been or may be adversely affected by abuse or neglect by any person shall make such

reports as are required by law.

Reports shall be directed to any of the following:

Any local or state enforcement agency

The Child Protective Services division of the Texas Department of Protective and

regulatory Services

If a professional has cause to believe that a child has been abused or neglected, that person

shall make an oral report as prescribed above not later than 48 hours after the hour the

person first suspects that the child has been or may be abused or neglected. In all instances,

a written report shall be made within five days to the same agency or department.

CLASSROOM

All classrooms shall display the following: Exit Classroom rules

Grading policy

Tutoring Schedule

Retesting Policy

Make-up work guidelines

Current student work

Fire Drill

Bad Weather Location

Site Evacuation

CLINIC

Students who experience illness should report to the clinic immediately. If the illness or problem is

of an emergency nature, students should proceed to the clinic right away, and report to the nurse or

nurse assistant. The school nurse and administrators are the only school personnel authorized to

call the paramedics. If a student experiences fainting, seizure of unknown origin, serious injury,

controlled bleeding, respiratory problem, etc., the following procedure should be used:

The teacher should remain with the student at all times.

The teacher will tell the nurse/administrator the nature of the emergency and the location.

The nurse/administrator will go to the emergency site immediately.

Someone will be posted by the front door to guide the paramedics to the site of the

emergency.

In non-emergency situations, students should obtain pass from the teacher before entering the

clinic. The nurse keeps a record of each clinic visit.

At intervals, students will be called to the clinic for health assessments, verification of

immunizations.

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MEDICATION POLICIES

Anyone bringing medicine to school observes the following:

All medication must be checked in the office upon arriving at school.

PRESCRIPTION: A prescription medication must appear in the original container and be

properly labeled with specific directions. A note from the parent must accompany the

medication giving permission for school personnel to administer.

OVER THE COUNTER: The medicine must appear in the original container with

directions on the label. A note from the parents and doctor is required. The doctor’s note

must include specific directions such as the medicine name, dosage and time to be given.

COMMUNICATION

PARENTS/GUARDIANS Please make every effort to communicate with each parent early in the school year. The first

encounter should be a positive one with general introductions.

The office personnel will continue to make every effort to inform each faculty member

when a parent/guardian has made an inquiry or needs information or wants to have a

conference with a teacher. The office personnel will place notes in the mailbox

immediately. You are encouraged to respond as soon as possible to the message request.

MAILBOXES Teachers are to check their mailboxes in the morning, during conference period and in the

afternoon before leaving school.

ELECTRONIC MAIL Teachers are to check their email during their conference period and before they depart for

the day.

MONTHLY CALENDER Events to be placed on the calendar and/or website must have a completed District Calendar

Form signed by Principal.

Maintenance & Transportation Request

Submitted under departments Maintenance/Transportation link on the District Website.

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ADVISORY SQUAD

Advisory Squad is a program implemented to bring teachers and parents together for the interest of the

students at Dawson Jr. & Sr. High School. Teachers are encouraged to advocate through Advisory

squads. The purpose of Advisory squads is to ensure that our students have a mentor on campus that

they or their parents can contact other than the usual office personal to get answers and check up on

their students. Your campus requirements are as follows:

To give every parent a personable contact at the school

To foster a one-on-one relationship between every student and his/her family

To monitor attendance

To monitor discipline

To ensure that Dawson Jr. & Sr. High School is fulfilling its role in monitoring student success

To obtain correct parent contact information

COPY ROOM GUIDELINES

The following guidelines must be adhered to:

No copyrighted material may be produced.

Teachers must plan ahead to ensure that materials are available as planned.

Copy front and back to conserve paper whenever possible.

Do not leave your class unattended to make copies.

COUNSELING AND GUIDANCE The counselor is available to counsel with students about career choices, school work, course

selection, personal problems, higher education, aspirations and any other problems or concerns that

may arise.

Counseling and guidance services are available both to the students and to parents. Students may

see the counselor by prearranged appointments. Parents may call for appointments.

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DRESS CODE

All staff will help enforce the student dress code. If questions arise, please contact the principal for

clarification.

EMPLOYEE DRESS CODE:

The dress and grooming of Dawson ISD employees shall be clean, neat, in a manner appropriate for

their assignments, and in accordance with any additional standards established by their supervisors

and approved by the Superintendent. Dress and grooming shall conform to the following

guidelines:

1. Clean and neatly pressed shirts, slacks, and suits shall be considered acceptable attire for

men.

2. Clean and neatly pressed dresses, slacks, skirts, and blouses shall be considered acceptable

attire for women.

3. All skirts shall come to the knee. Pants/capris may not be shorter than 5” above the ankle.

4. Wind suits shall not be permitted. Principals may make exceptions for workdays (not for

professional staff development days), field trips, or other school activities or specific job

assignments or conditions when informal attire is deemed more appropriate.

5. Jeans shall be permitted on Fridays, and should be free of holes and scuff marks.

6. Women’s clothing should not be revealing in cut, style, or material, and will have sleeves.

Tight fitting clothing is not permissible, and cleavage must be covered at all times.

7. Coaching shorts without cover-ups shall be worn only during physical education

instructional periods. During classroom instruction, PE/coaching staff must follow the

employee dress code.

8. Hair shall be clean and well groomed. Moustaches and beards are allowed if neatly

trimmed. Moustaches shall not extend past the corners of the mouth. Sideburns shall not

extend beyond the middle of the ear. Hair length for men shall be above the bottom of a

dress shirt collar.

9. Hats and caps shall not be worn in District buildings.

10. Ked-type shoes and sandals are allowed if they are clean and well kept. Dress casual shoes

are appropriate. Rubber or plastic footwear and flip flops are not permissible. Flip flops are

considered to be shoes which have a thong between the toes, sole of ½” or less, and are

rubber or plastic. If your shoes meet two of the three criteria, they are flip flops. “Crocs”

are not acceptable footwear for employees.

11. At all times, staff members should be in professional-looking attire, not casual.

12. Principals shall determine if dress and grooming are professionally appropriate.

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DRILLS

Fire, Lock-Down, Bad Weather, Campus Evacuation, & Site Evacuation drills will be

conducted throughout the year.

See Campus Crisis Pan for details of each drill.

HALL PASSES

Each Teacher will be provided a Hall Pass for students to use.

Students in the Hall without a hall pass will be escorted back to the class.

Students are not to be told to simply leave (i.e. get out) and be permitted to wander the

halls or hide for the remainder of the class period. If it becomes necessary to remove a

student from your class, a referral must accompany the student to the office.

A student may be put in the hall for the moment for the teacher to settle the remaining class,

assign work, and/or privately “conference” with the student in the hall. YOU MAY NOT

PERMIT A STUDENT TO REMAIN IN THE HALL FOR THE ENTIRE PERIOD

AS A DISCIPLINARY MEASURE. A STUDENT IN THE HALL OFTEN

DISRUPTS THE INSTRUCTION OF THE NEIGHBORING CLASSES.

LESSON PLANS

Teachers are required to turn in up-to-date lesson plans online via email.

Good planning is essential to ensure quality instruction for our students. It is suggested that each

class period begin with a Bell or Sponge activity in order to maximize instructional time and set a

tone of learning from the moment students enter class. The following procedure will be used to

collect and monitor plans:

Individual teachers may submit a copy of a current lesson plan to the Principal online (via

email) by 8:00 am on Mondays. Lesson plans may be turned in either two weeks or one

week increments.

LIABILITY Do not leave your class unsupervised. Get a neighboring teacher to watch or call the office to have someone come watch student.

We are liable for the safety and welfare of the students at Dawson High School. PLEASE DO

NOT LEAVE UNATTENDED STUDENTS FOR WHOM YOU ARE RESPONSIBLE. It is

imperative that we arrive on time for classes and all assigned duties. Do not abandon your

classroom or other duties to take care of personal matters. Should an emergency arise, teachers

must notify the office immediately.

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SECURITY

Each staff member should do the following when a visitor enters the building:

1. Greet the visitor.

2. Ask the visitor if he/she needs assistance.

3. Direct the visitor (including any who wishes to visit with a particular staff person or

persons) to the main office for a visitor’s pass, if they are not wearing one.

4. Observe that the visitor is proceeding to the proper destination.

5. Go to the nearest telephone to report to an administrator/security the refusal of a visitor

to comply with our directions (indicate his/her destination or if any doubt exists about

the visitor’s intentions). Go to the nearest classroom and ask a student to notify an

administrator if contact is not made by telephone.

FUNDRAISING

No faculty member or jr. & sr. high school student, individually or as a club or organization, may solicit money from merchants or individuals in the community for any activity without approval from the principal. All fundraising activities must be approved by the principal and within school board guidelines. There will be no collection of money or sales on campus by a non-school group. All approved fundraising activities will be placed on the principal’s calendar.

MOVIE REQUEST FORM Only movies with an educational purpose should be shown at Dawson Jr. & Sr. High School. Movie request must be approved by the Principal prior to showing. Videos that came with your curriculum or on United Streaming do not need a request form.

TUTORING

Tutoring must be made available for any student who is failing or is in danger of failing a class. It

is the teacher’s responsibility to offer tutoring sessions and to post the times and days appropriately.

Teacher D-Hall/Zeros

Teachers are required to assign Teacher D-hall for minor discipline issues and failure

to complete assignments. Teachers will need to make a phone call to parents about

missing assignments and assign Teacher D-Hall before issuing a zero in the

gradebook.

Students who fail to attend Teacher D-Hall will receive a referral slip to the principal

office.

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HIGH SCHOOL/ JUNIOR HIGH TARDY POLICY

Students are tardy to class when they are not in the room when the bell rings.

Teachers may not count students tardy due to them not being seated when the bell

rings

Students tardy to a class must be admitted to class with a tardy slip from the office.

Tardy Discipline will be handled by the principal as followed:

1st 2

nd 3

rd Tardy Warning

4th

5th 6

th Tardy Thursday School/Corporal Pun.

7th

8th

9th

Tardy Saturday School/Corporal Pun.

10 or more Tardies ISS/Corporal Punishment

*Tardies are totals not per class

THE TARDY COUNT WILL RESTART EVERY SEMESTER.

STUDENT IPADS

Teachers have control of the student usage of iPads.

I encourage teachers to use as much as possible but not only.

Student may lose iPad so supplemental work must be provided.

1st offense - 1 day loss

2nd

offense - 2 days

3rd

offense – 5 days

4th

offense – 10 days

5th

offense-Principal decision

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Classroom Discipline Procedures

All teachers will follow the Classroom Discipline Procedure & document using the Discipline Documentation form.

Classroom Discipline Procedure

1. Intervention/verbal warning/counsel by teacher & documentation 2. Parent contact and teacher D-hall & documentation 3. Additional parent contact and teacher D-hall & documentation 4. Office referral for continued misbehavior or progression of misbehavior after all

previous steps taken

Teachers will hold their own d-hall. D-hall forms will be provided for you to complete. You will give to the student and retain copy for your documentation. All disciplinary actions must be documented on the Discipline Documentation form which is provided. Once an office referral is made, the discipline form is your documentation of actions taken to correct the behavior of that student.

Some behaviors have been identified that require an automatic office referral. In these cases, teachers

should fill out an office referral form without needing to go through the steps of the classroom discipline

procedure. Upon sending a student to the office, teachers must submit a discipline referral to the

appropriate discipline administrator. These behaviors are our common discipline issues or, this list is not

all inclusive. Obviously, if a student commits a serious offense (see student Code of Conduct) an

automatic office referral is necessary. These will be posted in every classroom.

Behaviors Requiring Automatic Office Referral

Cheating Skipping class Uncorrectable or consistent dress code violation Fighting or confrontational behavior Profanity/Racial Slurs in class Refusing to surrender electronic devices Vandalism or defacing school property Non-compliance/defiance Refusal to attend teacher D-hall Public displays of affection

**Zero tolerance is supported for misbehavior with any substitute teacher, custodian, cafeteria worker, or secretary. In other words, these staff members do not need to follow the classroom discipline procedures before referring a student to the office.

TEACHER EVALUATIONS

The Texas Teacher Evaluation and Support System (T-TESS)

T-TESS includes three components:

Goal-setting and professional development plan

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The evaluation cycle (including: pre-conference, observation, post-conference)

Student growth measure

The T-TESS Rubric includes four domains:

Planning

Instruction

Learning Environment

Professional Practices and Responsibilities

USE OF TOBACCO ON CAMPUS

DAWSON ISD IS A SMOKE/TOBACCO FREE CAMPUS.

There will be no smoking or use of any tobacco on campus.

GRADING POLICY

Six weeks grades for seventh through twelfth grades shall be as follows:

50% - minimal of 12 daily grades

50% - minimal of 2 test grades.

To get Mid-Term grade: Add six weeks grades times two plus Exam.

Example – 70+70+72+72+76+76+80=516, Divide by 7=74

To get Final Grade add the two Semester grades together and divide by 2.

All paper-homework, test, daily work MUST be returned to students within 3 (three) days of due

date and before further test are given.

The District shall calculate a student’s class ranking using only credits earned in the following

content areas as defined by the Texas Essential Knowledge and Skills (TEKS)

1. English

2. Mathematics

3. Science

4. Social Studies

5. Foreign Language/College Foreign Language

6. College Math

7. College English

8. College American History

9. College Government/Economics

10. Honors Spanish III

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Grades are due in the system by 9:00 am on Mondays after each 3 weeks and 6 weeks periods for

Progress Reports and Report Cards. Grade verifications will be out by Tuesdays mornings. Changes

need to be made ASAP. Report cards will go out on Thursdays during Advisory Squad.

Teachers may give extra points for returned signed progress and report cards but may not

issue failing grades or zeros for non-returned reports. Discipline issues may not negatively

affect a student’s grade.

Grades must be entered at a minimum of once a week in order for parents to monitor students grade

from Parent Portal

Grades that are returned to the student and recorded in grade book and on Electronic Gradebook

MUST reflect the following chart according to as described in School Board Policy Handbook EIC

(Local):

Number

Grade

Regular

Grade

Advanced/Honors/

GT/College

Classes

100 4.0 5.0

99 3.9 4.9

98 3.8 4.8

97 3.7 4.7

96 3.6 4.6

95 3.5 4.5

94 3.4 4.4

93 3.3 4.3

92 3.2 4.2

91 3.1 4.1

90 3.0 4.0

89 2.9 3.9

88 2.8 3.8

87 2.7 3.7

86 2.6 3.6

85 2.5 3.5

84 2.4 3.4

83 2.3 3.3

82 2.2 3.2

81 2.1 3.1

80 2.0 3.0

* Transcript contain Dawson’s GPA (core classes) and College 4.0 Scale (all classes)

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ANNOUNCEMENT FORM All announcements must be placed in the “ANNOUNCEMENT” box by 4:00 p.m. on the previous day of the announcement. All sports events must be submitted no later than 8:00 a.m. the morning the announcement is to be made. Announcements submitted after the indicated time will not be announced. From:____________________________________________ To:______________________________________________ For:_____________________________________________ Dates(s) announcement is to be made:__________________

ANNOUNCEMENT:

_____________________________________

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Date_________________________ Please correct the attendance reported for: Last Name _______________________________ First Name _________________________________

Grade: 7 8 9 10 11 12 Date(s)to be corrected__________________________________________ Course__________________________________________________ Period to be corrected_________________________________ TYPE OF CORRECTION:

___ Present but marked absent ___ Marked absent but was tardy ___ Absent but not marked absent ___ Other________________________

___________________________ __________________________ Teacher’s name (printed) Teacher’s signature

ATTENDANCE CORRECTION FORM

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Dawson Independent School District

District Calendar Form

* Check calendar with Mrs. Martinez before submitting

*Athletic Events do not need to complete this form Event: _________________

Date of Event: _________________

Time of Event: _________________

Location of Event: __________________

Extra Information if needed: ______________________________

______________________________

______________________________

______________________________

Do you need this posted on the website? YES NO

Do you need this posted on the Marque? YES NO _________________ ________________ Teacher/Sponsor Date:

_______________________ _______________________ Robert Bray Shannon Martinez

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Dawson Independent School District

TARDY SLIP

Name: __________________ Date: ____________ Semester: 1 2 Period: 1 2

3 4 5 6 7 8

Warning 1 2 3

Thursday School 4 5 6 Date: __________ (3:30pm-4:30pm)

Saturday School 7 8 9 Date: __________ (8am-12pm)

ISS 10+ Date: ___________

*Students may request alternative punishment to substitute above discipline. ___________________ School Signature

Request Alternative Punishment: _______________________________________________ ___________________ ___________________ ___________________ Student Sign: Principal sign: Witness sign: PEIMS CODE: Disciplinary Reason Code: ________ Disciplinary Action Code: ________

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Dawson Independent School District

IPAD APP REQUEST FORM

Date of Request: ___________

Name of APP: ___________

Price of APP: ____________

How many needed: ____________

Explain how it will benefit your class:

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

_______________________________________________________________

_________________ ________________ Teachers Name Principal Name Approved Not Approved

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Student Copy

ZAP DETENTION ROOM HS5

Date: ______________ Student: _________________

Detention Date: _________________

* Report to HS7 room during your lunch, bring missing work. Your lunch

will be brought to you. Failure to complete work may result in additional

ZAP days or additional discipline.

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Teacher Student

Teacher Copy

ZAP DETENTION ROOM HS5

Date: ______________ Student: _________________

Detention Date: _________________

* Report to HS7 room during your lunch, bring missing work. Your lunch

will be brought to you. Failure to complete work may result in additional

ZAP days or additional discipline.

_______________ ________________________

Teacher Student

* Email Coach Miller the student’s name and date of ZAP detention

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General Discipline Issues and Actions

DESCRIPTION ACTIONS

Controlled Substance/Alcohol 3 Days OSS, Ticket, arrested (police decision), & DAEP

Break Code of Conduct School Detention or ISS or Corporal Punishment or OSS

Assault nonemployee OSS and/or DAEP

Tobacco Product 2-5 days ISS (length based on # record)

Non-Illegal knife 2-3 day ISS

Lighter 1-2 days ISS

Fighting 2-3 days OSS, & DAEP Recommendation

Fails to attend Thursday School ISS or Corporal Punishment

Fails to attend Teacher D-Hall Thursday School

Cut Class ISS or Corporal Punishment

Tardies Warning, Thur. School, Sat School, ISS, or Corporal Punish.

Truancy at least 3 unexcused Attendance Behavior Plan

Truancy 10 unexcused Saturday School, Court

Disruptive Behavior School Detention or ISS or Corporal Punishment or OSS

Leave Class w/out permission ISS or Corporal Punishment

Leave School w/out permission ISS or Corporal Punishment

Horse playing ISS, Corporal Punishment, or OSS

Robbery/Theft/Stealing ISS or Corporal Punishment or Ticket or OSS, and/or DAEP

Cheating 0 on assignment & 1 day ISS or Corporal Punishment

Verbal Altercation 2-3 days ISS

Profanity in Class room 2-3 days ISS

Tardy Thursday School, Corporal Punishment, or ISS

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HIGH SCHOOL/JUNIOR HIGH TEACHER HANDBOOK

2016-2017

Name____________________________________________________

Department_______________________________________________

I hereby acknowledge receipt of my personal copy of the Dawson ISD High School Teacher

Handbook. I agree to read the Handbook and abide by the standards, policies, and procedures

defined and/or referenced in this document.

The information in this handbook is subject to change, and I understand that changes in DISD

policies may supersede, modify, and/or invalidate any or all information contained herewith. I

understand that all Dawson ISD Board Policies are available in the district administrative offices. I

accept responsibility for becoming familiar with and abiding by any changes that are affected by the

Board of Trustees and/or Dawson ISD Administration during school year 2016-2017.

I understand that I have an obligation to inform my principal concerning any changes in my

personal information, e.g., mailing address, phone number, etc. Furthermore, I am aware that two

copies of this form are included with the High School Teacher Handbook; one copy is to be signed,

dated, and returned to the principal NLT August 22, 2016.

_________________________ ___________________

SIGNATURE DATE