alternative education services - erie 1 boces by division/alternative...alternative education...

Alternative Education ServicesNorthtowns Academy

333 Dexter Terrace, Tonawanda, NY 14150Tel. (716) 961-4030 Fax (716) 694-5576

www.e1b.org

Akron • Alden • Amherst • Cheektowaga • Cheektowaga-Sloan • Clarence • Cleveland Hill • Depew • Frontier • Grand Island • HamburgHopevale • Kenmore • Lackawanna • Lancaster • Maryvale • Sweet Home • Tonawanda • West Seneca • Williamsville

Northtowns Student Packet

Please check the appropriate box: o ALP 9-12 o ALP w/parenting o ALP w/Work Component o Erie 1 Middle School

Northtowns AcademyStudent Information - Data Form

Student Information

Name ____________________________________________________________________________________________

Address __________________________________________________________________________________________ street __________________________________________________________________________________________ city, state, zip

Date of Birth ____________________________________ Sex (cirle one): M F

Student # _________________________________________________________________________________________

Home School ______________________________________________________________________________________

Guidance Counselor ________________________________________________________________________________

Sept. Grade _____________________________________ School Code _____________________________________

Contact InformationStudent Resides (please check one): o Mother & Father o Mother o Father o Other _________________________ explain

Father’s Name ___________________________________ Mother’s Name ___________________________________

Home Phone ____________________________________ Home Phone _____________________________________

Work Phone _____________________________________ Work Phone _____________________________________

Cell Phone/Pager ________________________________ Cell Phone/Pager _________________________________

E-mail _________________________________________ E-mail __________________________________________

Address ________________________________________ Address _________________________________________ (if different from student) (if different from student)

Emergency Information

Name (other than parent) _______________________________________________________________________________

Relationship to student ______________________________________________________________________________

Address __________________________________________________________________________________________ street, city, state, zipHome Phone ____________________________________ Work Phone _____________________________________

Health/Medical Information

Any medical concerns/Allergies (please list): _______________________________________________________________

_________________________________________________________________________________________________

Current Medication (please list) _________________________________________________________________________

_________________________________________________________________________________________________

Doctor Name ____________________________________ Phone __________________________________________

Preferred Hospital ________________________________

ALP 9-12(716) 961-4030 • (716) 961-4040 • (716) 694-5576 Fax

Erie 1 Middle School(716) 961-4050 • (716) 694-9753 Fax

Office Use Only:Entry Date:_________

Today’s Date_______



www.e1b.org



(Check the appropriate box with information pertaining to the above child)

YES NO

CSE/IEP (classification) o o

1st Time/Last Time o o

PINS o o

Probation o o

Reason: ____________________________________________________________________________________________

____________________________________________________________________________________________________

Officer Name:_________________________________________________________________________________________

Phone Number: _______________________________________________________________________________________

How Long: ___________________________________________________________________________________________

Any other information that the school should be aware of:

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

_______________________________________________ __________________________________________________

Parent Signature Authorizing School Signature

Erie 1 BOCES Graphics & Printing #1200289_REV 8-11

Confidential Information

Student’s Name: ______________________________________________________________________________________

It is vital that the Northtowns Academy be able to contact an adult connected to the student either as a family member or a family friend during the course of the school day: (7:45 a.m. - 2:15 p.m. Monday - Friday).

Please list 3 names and numbers to be called during the school day should it become necessary. The most available person should be listed first. (Parent MAY or MAY NOT be first).

Name Number Relationship

________________________________ ________________________________ ________________________________

________________________________ ________________________________ ________________________________

________________________________ ________________________________ ________________________________

Please list a secure telephone number to be used for Attendance Verification: _________________________________



www.e1b.org



Student ContraCt

Student’s Name: ___________________________________________________ Date: __________________

Home School: ____________________________________________________ Grade: _________________

I, ______________________________________________________________ , agree to:

• worktomaintaina90%rateofattendance.ThismeansthatIwillreporttoschool,ontime,9outof10days. • successfullycompletemyacademicwork • attendclassesnotformallyscheduledifanyofmyteachersrequestit. • refrainfromtheuseofanycontrolledsubstanceprior to attendance on any day at ALP, while in attendance at

ALP, and while I am on the bus. • actinamature,responsiblemanner • treatmyteachers with respect. • treatmypeers with respect. • treatmyself with respect.

I, ______________________________________________________________ , understand that:

I have the right to expect: • asafe,positivelearningenvironment. • tobetaughtthematerialIneedtolearninordertograduatefromhighschool. • thatmyteacherswillmakeeveryefforttopresentthismaterialtomeinawaythatIcanlearn. • thatpeoplewilltreatmewithrespect.

The work study student will: • Attendschoolandworkduringtheassignedtimes. • IwillcontactschoolandmyworksupervisorifIamgoingtobeabsent/late. • Iwilldiscusscontroversialjobproblemswiththeworkcoordinator. • Iwilldisplaygoodworkhabitsatalltimes.

The parent(s)/guardian(s) agree: • thatthestudentwillmakeacommitmenttoALPforoneyear. • toattendaminimumofoneconferenceforthefirsttwomarkingperiods.If the student is performing at, or

above, expectations, then the third marking period conference may be waived. If the student is not performing at, or above, expectations, then the parent will attend the third marking period conference.

• beavailableforconferencesregardingpooracademicperformance,orattendanceissues. • toattendareadmitconferenceifthestudenthasbeenputonout-of-schoolsuspension.

The parent(s)/guardian(s) understand: • theconferencesreferredtoaboveareavaluablepartofourprogramandthat,iftheyrefusetoattend,thenthe

student may not be allowed to attend classes with the general population until the conference is conducted. • schoolpersonnelwillalwayscontactparent(s)and/orguardian(s)if: - their student is absent from school. - their student leaves school without permission. - their student is placed in out-of-school suspension.



www.e1b.org



• schoolpersonnelwillcontactparent(s)and/orguardian(s)if: - their student is placed in in-school suspension unlessparent(s)specificallyrequestsaphonecalluponin-

school suspension, or if a student is placed in in-school suspension more than twice within a four week period.

The Home School will: • referstudentsforprogramparticipation. • awardcreditforsatisfactoryperformanceinprogramcoursesasrecommendedbytheALPprincipal. • awardahighschooldiplomawhenNewYorkStateEducationandlocalrequirementsaremet. • allowstudentstoparticipateinallextra-curriculareventsaslongasthestudentisingoodstandingwithboththe

Home School and Northtowns Academy, ALP.

The instructional and administrative staff at Northtowns Academy, ALP agrees to: • ensureasafe,positivelearningenvironmentforstudents. • provideinstructioninrequiredcontentareas. • acknowledgeandaccomodateindividuallearningneeds. • ensureadequatesupervisionandcounselingforeachstudent. • provideavarietyofopportunitiesfortheindividualstudenttoadjusttotheroleofanindependentself-motivated

learner. • provideeachstudentwithacopyofthestudenthandbookandacopyoftheNYS/Erie1BOCESCodeofConduct. I have read, and understand this document and will make a commitment to honor this agreement.

Home School: ____________________________________________________ Grade: _________________

Student: _________________________________________________________ Date: __________________

Parent/Guardian: __________________________________________________ Date: __________________

A.L.P. Representative: ______________________________________________ Date: __________________

Please initial below that you have received the following: • StudentHandbook______ • NYS/Erie1BOCESCodeofConduct______ • SchoolCalendar______



www.e1b.org



DATE: __________________________

Student’s Name __________________________________________________

Ethnicity * o American Indian o Asian o Black o Hispanic o White

authorization For releaSe oF inFormation

For the period of time that my son/daughter, ________________________________________________________is in attendance at the Erie 1 BOCES, Northtowns Academy, 333 Dexter Terrace, Tonawanda, NY 14150, I hereby authorize my child’s school district of residence, to __________________________________________________ (Name of school, agency or organization)

furnish information and/or records relative to my child to Erie 1 BOCES, Northtowns Academy, or its agent.

Itisunderstoodthattheorganizationrequestedtofurnishinformationisreleasedfromanyliabilitywhichmayarisefrom this act. RECORDS TO BE FURNISHED: Academic, Guidance, Health, Medical, Discipline, Psychologi-cal and any information maintained by the district of residence regarding legal proceedings such as PINS, probation reports, etc.

____________________________________________ ___________________________________________ Parent/Guardian Signature Student Signature

authorization to PartiCiPate on Field triPS and SPeCial eventS

I further authorize the above named student permission to attend all field trips and special events during the up-coming school year. I give permission to use my child’s picture in information and publicity generated through Erie 1 BOCES.‘ ___________________________________________ Parent/Guardian Signature

SChool textbookS, SuPPlieS and equiPment

Textbooks,schoolsuppliesandequipmentareanintegralpartofthelearningprocess.Toinsurethatallstudentshave the opportunity to use and learn via these resources, we will assess a replacement cost for any item misused or carelessly damaged. Prior to releasing any academic information (grades, credits or report cards), all financial obligations must be satisfied.

I Understand and Agree to the Above ___________________________________________ Parent/Guardian Signature

SChool attire

-School attire should not be offensive, disruptive or have the potential to endanger the safety, health, morality or welfareofstudentsorstaffinschooloronthejobsite,andfollowprogramDressCodespecifiesasstatedinthestudent handbook.

I Understand and Agree to the Above ___________________________________________ Parent/Guardian Signature

*Information provided will be used by Erie 1 BOCES solely for the purpose of meeting its obligation to maintain and/orreportsuchinformationtotheStateEducationDepartmentortootherapplicableentitiesasrequiredbylaw.



www.e1b.org



Student’s Name ___________________________________

Northtowns Academy ProgramsComputer System Regulations

Violation of the Northtowns Academy Computer System, (NACS) regulations will result in disciplinary action which may include federal, state and local laws.

The following specific activities shall be prohibited by student users of the NACS:

• Using the computer system to obtain, view, download, send, print, display or otherwise gain access to or to transmit materials that are unlawful, obscene, pornographic or abusive.

• Use of obscene or vulgar language.

• Harassing, insulting or attacking others.

• Damaging, disabling or otherwise interfering with the operations of computers, computer systems, software or related equipmentthroughphysicalactionorbyelectronicmeans.

• Using unauthorized software on the computer system.

• Changing, copying, renaming, deleting, reading or otherwise accessing files or software not created by the student without express permission from the computer coordinator.

• Violating copyright law.

• Disclosing an individual password to others or using others’ passwords.

• Revealing personal information about oneself or of other students including, but not limited to, disclosure of home address and/or telephone number.

• No food or drinks of any kind are permitted anywhere near any computers in the building.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * In consideration for the privilege of using the Northtowns Computer System, I agree to adhere to the above policy and any changes or additions later adopted. I also agree to adhere to related regulations published in the Student Handbook.

I understand that failure to comply with this regulation may result in disciplinary action. I further understand that the District reserves the right to pursue legal action for willful, malicious damage or destruction of District computer property (hardware/software).

_______________________________________________________________________ ___________________________ Student Signature Date As parent/legal guardian, I have read and understand the above NACS regulations as they relate to my son/daughter. I also understand the benefits and corresponding responsibilities that must be adhered to. I support and agree to reinforce the programs’ regulations as they apply to the NACS.

_______________________________________________________________________ ___________________________ Parent/Legal Guardian Signature Date



www.e1b.org



Dear Parents/Legal Guardians,

Please be aware of the current medication policy for the building. If your child will require any medications during the school day I will need written consent from both you and your child’s physician. There is a standard form, which will need to be filled out, and kept in the health office for each medication your child needs. There is also a form needed if your child will need to carry an inhaler with him/her. A new form is required with the start of each new school year.

If your child will require prescription or over the counter medications (including tylenol/advil/motrin) I will need the form completed. Also all mediations must be provided by you, and be in a original labeled bottle. If the medication is a controlled substance such as adderal/ritalin it must be brought to school by a parent or arrangements must be made with me if you can’t bring the meds in. All medications will be labeled and given only to your child.

All orders for medications must include name of medication, dose, time to be given (may state as needed for medications like tylenol), duration to be taken, and side effects. If the medication is to be taken throughout the school year, that should be stated. Also be aware if a prescription medication dose changes during the year I will need to receive an updated letter from both you and the physician along with a corrected prescription bottle.

If I do not have the needed information, I will be unable to dispense any medications to your child. Also be aware it is against school policy for any student to have any medications in their possession without the permission to carry form filled out and on file in my office. Thank you in advance for your cooperation.

Julie Murray, RNSchool NurseNorthtowns Academy at Dexter Terrace



www.e1b.org



Parent and PreSCriber’S authorization For adminiStration oF

mediCation in SChool and SChool aCtivitieS

Authorization for Administration of Medication

A. To be completed by the parent or guardian:

I request that my child ____________________________________________________________ Grade/Date of Birth

_____________________________ receive the medication as prescribed below by our licensed health care prescriber. *the medication is to be furnished by me in the properly labeled original container from the pharmacy. I understand that the school nurse, or other designated person in the absence of the school nurse, will administer the medication, including field trips.

Signature (Parent or Guardian) _____________________________________________________________________

Address; _______________________________________________________________________________________

Telephone: Home ______________________ Work ________________________ Date ________________________

B. To be completed by the licensed health care prescriber:

I request that my patient, as listed below, receive the following medication:

Name of Student: ______________________________________________________ Date of Birth:_______________

Diagnosis: ______________________________________________________________________________________

Name of Medication: _____________________________________________________________________________

Prescribed Dosage, Frequency and Route of Administration:

______________________________________________________________________________________________

Time to be Taken During School Hours: ______________________________________________________________

Duration of Treatment: ____________________________________________________________________________

Possible Side Effects and Adverse Reactions (if any):____________________________________________________

______________________________________________________________________________________________

Other Recommendation: __________________________________________________________________________

______________________________________________________________________________________________

Name of Licensed Prescriber and Title (please print): ____________________________________________________

Prescriber’s Signature _________________________________________________________ Date ________________________

Address: _________________________________________________________Phone: ________________________

*Medication must be in original pharmacy labeled container with specific orders and name of medication. *Medication and refills must be brought to school by parent, guardian or responsible adult.



www.e1b.org



Erie 1 BOCES Code of ConductSummary Document

The full version of this Code is available by contacting an Erie 1 BOCES building principal or supervisor.

The Erie 1 BOCES Code of Conduct has been written to comply with the Project SAVE legislation-the Safe Schools Against Violence in Education Act.

The Erie 1 BOCES Code of Conduct pertains to:

Who?All students, BOCES personnel, parents, and other visitors when on BOCES property or attending a BOCES function. BOCES programs or services provided in other schooldistrict locations shall comply with that district’s Code of Conduct, unless otherwiseauthorized.

Where?Any owned or leased BOCES property, building, equipment or structure; BOCES supervised school bus; BOCES sponsored extracurricular event or activity; or a BOCES sponsored work site/ internship.

When?This Code takes effect July 1, 2001.

Why?Erie 1 BOCES is committed to providing a safe and orderly educational environment where students receive and BOCES personnel deliver quality educational services without disruption or interfer-ence. This new law seeks to improve school security and ensure a safe and effective learning environ-ment.

The Erie 1 BOCES Code of Conduct contains provisions regarding:• Students’ rights and responsibilities;• Appropriate conduct, dress and language;• Security and safety of students and personnel;• Prohibited student conduct;• Disciplinary consequences and procedures;• Disciplinary measures to be taken for incidents involving illegal substances, weapons, the use of

physical force, vandalism, violation of another student’s civil rights, harassment and threats of violence;



www.e1b.org



• Student removal from a classroom, BOCES property or BOCES function for substantially disruptive behavior;

• Compliance with state and federal laws relating to students with disabilities;• Law enforcement notification for Code violations which constitute a crime;• Parent/person in parental relation to the student notification of Code violation;• Juvenile delinquency petition or person in need of supervision (“PINS”) petition;• Referrals to appropriate human service agencies;• Minimum suspension periods for students who are violent or who repeatedly are substantially dis-

ruptive or substantially interfere with the teacher’s authority over the classroom;• Visitors to the BOCES;• Public Conduct on BOCES property;• Dissemination of the Code of Conduct.

For questions or comments regarding this Code of Conduct or to obtain a full version of the Erie 1 BOCES Code of Conduct, contact an Erie 1 BOCES building principal or supervisor.



www.e1b.org



Erie 1 BOCES Attendance PolicySummary Document

The full version of this Policy is available by contacting an Erie 1 BOCES building principal or supervisor.

Erie 1 BOCES has developed a Student Attendance Policy to raise student achievement, ensure student safety and verify student com-pliance with education laws of compulsory attendance.

The Erie 1 BOCES Attendance Policy includes:

• Statementofoverallobjectives;• Descriptionofstrategiestomeetobjectives;• Determinationofexcusedandunexcusedabsences,tardinessandearlydepartures;

Excused: An absence, tardiness or early departure may be excused if due to:Personal illness, illness or death in the family, impassable roads due to inclement weather, religious observance, quarantine, required court appearances, medical appointments, pre-approved college visits, approved cooperative work programs, mili-tary obligations, home school excused, approved BOCES-sponsored activities or other such reasons as may be approved by the administration.

Unexcused: If the reason for the lack of attendance does not fall into the above excused categories.

Written excuses must: fall into the above excused categories, be received within ten (10) school days, include date, reason for absence and parental signature.

After 10 school days if no note is received, the absence will be recorded as unexcused.

• Studentattendancerecordkeeping/datacollection;• Student attendance/Course credit:

Students in BOCES programs will be held accountable as follows:

- Any student with more than 27 absences in a course may not receive course credit;- Excused absences with completed make up work will not count as an absence for credit eligibility;- Calculation of absences for _ year or _ year courses will be prorated;- Transfer students attendance will be prorated.

• Noticeofminimumattendancestandard/interventionstrategiespriortothedenialofcoursecredit;• Noticeofstudentswhoareabsent,tardyordepartearlywithproperexcuse;• Attendanceincentives;• Disciplinaryconsequences;• Interventionstrategyprocess;• Appealprocess;• Buildingreviewofattendancerecords;• Annualreviewbytheboardofeducation;• Communityawareness.

For questions or comments regarding this Attendance Policy or to obtain a full version of the Erie 1 BOCES Student Attendance Policy, contact an Erie 1 BOCES building principal or supervisor.

alternative education services - erie 1 boces by division/alternative...alternative education...

Documents