bring this card with you on your … · file: js-e1 lewis-palmer school district 38 ... after prom...

BRING THIS CARD WITH YOU ON YOUR SCHEDULED

CLASS CHANGE AND PROCESSING DATE

If no class change is needed, you may line up at the main entrance doors to begin processing

anytime between 10:00 a.m. – 12:00 p.m. on Wednesday, August 12th.

If you need a schedule change, proceed to Student Services first.

STUDENT’S NAME (Please print)____________________________________________

_____ Print out Schedule and

Fee Billing Statement Bring your Schedule and your Fee Billing Statement to processing. (These are available on Infinite Campus.)

Locker info will print on student’s schedule if this option is chosen under Reports in the schedule window.

_____ Turn in Forms: Signed : Student Handbook Signature Page, District Technology User Forms, Family Information Form, Volunteer Form (Optional),

Reduced Lunch Application (if applicable).

_____ Fees Pay annual $30 District Media Resources Fee and any class fees. SEPARATE PAYMENT: CHECK OR CASH.

Fees may also be paid online with credit card or e-check through MyCampus via Parent Portal with the

PaySchools link. (If paying online, print Fee Billing Statement after payment has been made.)

_____ Athletic Pass (Optional) See page for additional information. SEPARATE PAYMENT: CHECK OR CASH.

Note that if student earned a 4.0 GPA for the spring 2015 semester at LPHS, he/she has earned a Gold Card and has free

admittance to home regular season athletic events for the fall 2015 semester (excluding ice hockey).

_____ School IDs IDs will be distributed upon receipt of signed Student Handbook Signature Page and last year’s ID at this station

_____ School Pictures (Optional) See page for additional information. SEPARATE PAYMENT: CHECK, CASH, OR ONLINE.

——- ZPass Bus Service (Optional) See page for additional information. SEPARATE PAYMENT: CHECK OR CASH.

_____ Yearbook Purchase (Optional) See page for additional information. SEPARATE PAYMENT: CHECK OR CASH.

_____ LPHS Spirit Wear (Optional) Booster Club will be selling LPHS clothing. SEPARATE PAYMENT: CHECK OR CASH.

_____ Parking Permit (Necessary if driving to school and parking.) Bring requested copies and completed forms to purchase a permit.

SEPARATE PAYMENT: CHECK OR CASH. All fees/fines must be paid in order to purchase a permit.

_____ Return Completed Health Information Forms

_____ Vision and Hearing (New students only)

Testing

_____ Textbook Distribution Textbook Damage Report may be done today or returned to Media Center by August 29th.

_____ Pick up LPHS Bumper Sticker / EXIT building

10th Grade

Level Card

LPHS Student Handbook Signature Page

2015-16

The LPHS Student Handbook is located on line at www.lphs.lewispalmer.org in the

Back to School Documents located under the Parent & Student Information

tab. Please initial your acknowledgement of accessing, reading and understanding

the LPHS Student handbook below.

Student

Initials

Parent

Initials

______

______

______

______

LPHS Honor Code - page 11

LPHS Academic Guidelines - page 12

______ ______ LPHS Dress Code - page 29

______

______

______

______

______

______

______

______

______

______

______

______

LPHS Behavior and Discipline Code (Board Policy JICDA) - 24

LPHS Attendance & Make-Up Work Policy - page 15 & 18

LPHS Standardized Testing Expectations - page 36

LPSD #38 Infinite Campus Guidelines and Usage - page 33

LPSD #38 Technology Resources Agreement - page 38

LPHS Athletic Handbook – page 45

It is the intent of this booklet to inform students and parents about major

expectations. Not every situation can be anticipated and will be addressed as it

occurs. Information contained herein may be adapted or altered by the

administration on an as needed basis. Specific operational policies may be

referenced at www.lewispalmer.org or by contacting: Director of Personnel and

Student Services (719)488-4700.

Print Student’s First and Last Name___________________________________

Student’s Signature _______________________________________________

Parent’s Signature_________________________________________________

Today’s Date ______________________

Grade Level (circle) 9th 10

th 11

th 12

th

http://www.lphs.lewispalmer.org/

http://www.lewispalmer.org/

File: JS-E1

Lewis-Palmer School District 38

STUDENT Network and Technology Equipment Agreement Form

Board of Education Policy File:JS

1. Student Agreement: Must be signed by students in grades 3-12

I have read and understand the Student Use of LPSD Technology Resources, the Internet and Commu-nication Systems Policy (Board Policy JS). I will abide by the guidelines contained therein. I understand that should I commit any violation, my access privileges may be revoked and disciplinary and/or legal action may be taken. I understand that Internet and computer usage can be monitored. I further understand and will abide by the following:

• Any form of gaming is not permitted on the Lewis-Palmer School District network. • My password is confidential and must not be shared with others. • My student folder is limited in size and is for educational purposes only.

Student (please print) ________________________________________ Grade _______ Student Signature: ____________________________________________ Date: ___/___/___

2. Parent or Guardian Internet Agreement: Must be signed by parents of K-12 students.

As the parent or guardian of this student, I have read and reviewed the Student Use of LPSD Technol-ogy Resources, the Internet and Communication Systems Policy (Board Policy JS). I understand that this Internet access is designed for educational purposes; however, I acknowledge it is impossible to restrict access to all controversial materials and I will not hold Lewis-Palmer School District responsible for materials acquired while using District Network Services.

Please Check One (Do Not Edit) _____ I give my permission for the student named above to access the Internet and all other com-puter resources. I certify that the information contained on this form is correct. _____ I do not give my permission for the student named above to access the Internet on the Net-work (lack of parental permission will result in loss of Internet access only, all other computer resources will be made available). Parent or Guardian (please print): ________________________________________________ Parent Signature: _______________________________________ Date: ___/___/___ If you would like to change Internet access status for your student, please contact the school.

Return this form to your school office. Revised 06.28.2010

LPHS Family Information 2015-16 Parent Name: Email Address:

Cell Phone: Home Phone:

Student: Grade: Student: Grade:

Student: Grade: Student: Grade:

Student involvement (check all that apply):

Band: Golf: boys’ girls’ Swim/Dive: boys’ girls’

Baseball: Basketball: boys’ Cheer: Cross Country:

girls’

Gymnastics*: Hockey: Lacrosse: boys’ Poms:

girls’ *

Tennis: boys’ Track: boys’ Volleyball: Wrestling:

girls’ girls’

Field Hockey*: Football:

Soccer: boys’ Softball:

girls’ * District Team through PRHS

FYI: LPHS does not have a PTO, instead we have Booster Club and a Building Accountability Committee (BAC). Our Booster Club is a 501c3 which provides financial support to our sports teams and bands by selling concessions, spirit wear, and fundraising. Our BAC meetings provide important information about what is going on at LPHS and often feature presentations from district administrators and community professionals.

You can support LPHS students and staff through your volunteer efforts. Please look over the following volunteer opportunities and check all that you may be interested in:

Adopt-A-School After Prom August Processing Baccalaureate Building Accountability (BAC) Classroom

Concessions Dances DECA Judging Field Trip Food Donations High Tech Space

Library

Picture Distribution

Spirit Wear Sales Senior Breakfast Decorate Senior Sunset/BBQ _____ Staff Appreciation Volunteer Coordinator Yearbook _____

Would you be willing to chair or represent any of the above organizations either this year or in the future?

Yes No

Do you have special skills or experiences (i.e. business owner, veteran) that you would be willing to share with our students?

For detailed information about these opportunities plus additional ways to get involved in LPHS, please visit http:// lphs.lewispalmer.org, click on Parents and Students, then click on Volunteers. You may also email the volunteer coordinator at [email protected] with any questions, suggestions, or to learn more about volunteering at Lewis-Palmer High School. We couldn’t do it without you!

mailto:[email protected]

Lewis-Palmer School District #38 Volunteer Services Agreement

Thank you for agreeing to volunteer your services in the Lewis-Palmer School District #38 (D38). Please affirm your acceptance of the terms of your agreement to volunteer, as stated below, with your signature.

1. I agree to participate in activities in . (school) 2. I agree to volunteer: (Please check which applies) supervised unsupervised

Supervised = assisting in the office or classroom. Unsupervised = working alone with student(s).

3. I consent to D38 performing a background check and understand that I may be ineligible for volunteering

based on the results. If necessary, due to being unsupervised with students, I agree to be fingerprinted by a law enforcement agency before volunteering begins.

4. I agree that volunteering in this activity is an act of donating my labor, and possibly my own use of my

personal vehicle, free of choice, and agree to perform assigned tasks in a responsible manner. I understand that volunteering for D38 is not an exchange for any consideration, such as pay, academic credit, fringe benefits, the promise of future employment, or promoting my own personal/professional ventures.

5. I agree to assume the risks of personal property damage, injury, illness or death associated with

participation in this activity and I agree to release D38, it’s employees, agents, representatives, and other volunteers from any or all liability that may arise in connection with this activity. I agree that the terms hereof shall serve as an assumption of risks and release for any heirs, estate, executor, administrator, assignees, and for all members of my family.

6. I understand I will not be covered by worker’s compensation laws in connection with this volunteer

activity.

7. I understand that, as a volunteer, I will not be an employee. D38 and I both hold the right to end my volunteer relationship at any time, for any reason, with or without advanced notice.

8. I understand that the work I perform, and intellectual property I may create in the course of my D38

activities belongs to D38 and I have no rights of ownership.

9. I agree to abide by all applicable D38 policies and not disclose any confidential information concerning students, their guardians, employees, unpublished documents or other confidential information of which I may learn in the course of my volunteer service.

_____________________________________________________ _____________________________ Volunteer (Print) Name Volunteer Phone Number _____________________________________________________ _____________________________ Volunteer Signature Today’s Date _____________________________________________________ Parent’s Signature (if volunteer is a minor under 18 yrs old)

Please take this form to Personnel Services in the District Administration building, located at 146 N. Jefferson St

in Monument. You will be asked to sign an Oath Form and permission slip for background check. Unsupervised volunteers will need to be fingerprinted at their own expense. Fingerprinting fees may run as high as $60. Once all paperwork is completed, the school(s) will be notified.

1

LEWIS-PALMER SCHOOL DISTRICT 38

LETTER TO HOUSEHOLDS

2015-2016

Dear Parent/Guardian:

Children need healthy meals to learn. Lewis-Palmer School District 38 offers healthy meals every school

day. Breakfast costs $1.75 for students in grades K-5 and $2.00 for students in grades 6-12; lunch costs

$2.65 for students in grades K-5 and $2.90 for students in grades 6-12. Your children may qualify for free

meals or for reduced price meals. The reduced price is $ .40

for lunch.

*Students in all grades that qualify for reduced price meals

will receive breakfast at no charge. Students in preschool

through 5th grade who qualify for reduced meals will also

receive lunch at no charge.

Complete one Free and Reduced Price School Meals

Application for all students in your household. We cannot

approve an application that is not complete, so be sure to fill

out all required information. Return the completed

application to: Lewis-Palmer School District Nutritional

Services, 1300 Higby Rd, Monument, CO 80132, or to

the secretary of your school who will forward the

application to Nutritional Services.

**Please note that for up to 30 operating days into the new

school year, eligibility from the last year will continue. When

this carry-over period ends, unless the household is notified that their children are directly certified or the

household submits an application that is approved, the children must pay full price for school meals and

the school will not send a reminder notice or a notice of expired eligibility.

Here are answers to questions you may have about applying:

1. Who can receive free meals? All children in households receiving benefits from the Supplemental

Nutrition Assistance Program (SNAP) and children in households that participate in the Food

Distribution Program on Indian Reservations (FDPIR) are eligible for free meals regardless of your

income. If one case number is provided on the application, free meal benefits will apply to all

students listed on the application. Also, your children can receive free or reduced price meals if

your household income is within the free limits on the Federal Income Eligibility Guidelines.

If you have received a NOTICE OF DIRECT CERTIFICATION for free meals, do not complete the

application. But do let the school know if any children in your household are not listed on the

NOTICE OF DIRECT CERTIFICATION letter you received.

2. Can foster children receive free meals? Yes, foster children who are under the legal

responsibility of a foster care agency or court are eligible for free meals. Any foster child in the

household is eligible for free meals regardless of income. For a household that has foster and non-

foster children, the foster child may be listed on the application as a member of the foster family,

as this may help other children in the household to qualify for benefits. If the foster family is not

eligible for free meals it does not prevent the foster child from receiving free meal benefits.

Federal Income Eligibility Guidelines

SY2015-16

Household

Size

Yearly Monthly Weekly

1 $21,775 $1,815 $419

2 $29,471 $2,456 $567

3 $37,167 $3,098 $715

4 $44,863 $3,739 $863

5 $52,559 $4,380 $1,011

6 $60,255 $5,022 $1,159

7 $67,951 $5,663 $1,307

8 $75,647 $6,304 $1,455

For each

additional

family

member

add:

$7,696 $642 $121

2

3. Can homeless, runaway, Head Start and migrant children receive free meals? Yes. If you

have not already received notification that your child(ren) qualify for free meals, complete the meal

application and indicate the child’s status: homeless, runaway, Head Start or migrant. In addition

call Jim Taylor (LPSD Registrar) at 719-488-4700 to see if your child(ren) qualify.

4. Who can receive reduced price meals? Your children can receive reduced price meals if your

household income is within the limits on the Federal Eligibility Income Chart.

5. Should I fill out an application if I received a letter this school year saying my children

are approved for free meals? Please carefully read the letter you received, and follow the

instructions. Call your child’s school if you have questions.

6. My child’s application was approved last year. Do I need to fill out another one? Yes. Your

child’s application is good only for that school year and for the first few days of this school year.

You must send in a new application unless the school told you that your child is eligible for the new

school year.

7. I receive benefits from the WIC Program. Can my child(ren) receive free meals? Children

in households participating in WIC may be eligible for free or reduced price meals. Please fill out an

application.

8. Will the information I give be checked? Yes, and we may ask you to send written proof of the

information you provide.

9. If I don’t qualify now, may I apply again later? Yes. You may apply at any time during the

school year if your household size increases, income decreases, or if you start receiving SNAP or

FDPIR. If you lose your job, your children may be able to receive free or reduced price meals if the

household income drops below the income limit.

10. What if I disagree with the school’s decision about my application? You should talk to

school officials. You also may ask for a hearing by calling or writing to: Mrs. Cheryl Wangeman,

Assistant Superintendent, Lewis-Palmer School District 38, P.O. Box 40, Monument, CO

80132. Telephone: 719-488-4703.

11. May I apply if someone in my household is not a U.S. citizen? Yes. You or your child(ren) do

not have to be a U.S. citizen to qualify for free or reduced price meals.

12. Whom should I include as members of my household? You must include all people living in

your household, related or not (such as grandparents, other relatives, or friends) who share

income and expenses. You must include yourself and all children who live with you. If you live with

other people who are economically independent (for example, people whom you do not support,

who do not share income with you or your children, and who pay a pro-rated share of expenses),

do not include them.

13. What if my income is not always the same? List the amount that you normally receive. For

example, if you normally receive $1000 each month, but you missed some work last month and

only received $900, put down that you receive $1000 per month. If you normally receive overtime

pay, include it, but do not include it if you work overtime only sometimes. If you have lost a job or

had your hours or wages reduced, use your current income.

14. We are in the military; do we include our housing allowance as income? If you receive an

off-base housing allowance, it must be included as income. However, if your housing is part of the

Military Housing Privatization Initiative, do not include your housing allowance as income.

15. My spouse is deployed to a combat zone. Is his/her combat pay counted as income? No, if

the combat pay is received in addition to his/her basic pay because of his/her deployment and it

3

was not received before he/she was deployed, combat pay is not counted as income. Contact your

school for more information.

16. My family needs more help. Are there other programs for which we might apply? To find

out how to apply for other assistance benefits, contact your local assistance office. Colorado PEAK

is an online service to screen and apply for medical, food, and cash assistance programs. It can be

accessed at http://coloradopeak.force.com/.

17. Is the social security number required? While disclosure of the last 4 digits of a social security

number is voluntary, for an application to be approved, the last 4 digits of a social security number

or an indication of “none” is required for approval of the application.

If you have other questions or need help, call Katie Dubois, Nutritional Services Supervisor, at 719-

488-4726.

Sincerely,

Cheryl Wangeman

Cheryl Wangeman Assistant Superintendent

Use of Information Statement: The Richard B. Russell National School Lunch Act requires the

information on this application. You do not have to give the information, but if you do not, we cannot

approve your child for free or reduced price meals. You must include the last four digits of the social

security number of the adult household member who signs the application. The last four digits of the

social security number is not required when you apply on behalf of a foster child or you list a

Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF)

Program or Food Distribution Program on Indian Reservations (FDPIR) case number or other FDPIR

identifier for your child or when you indicate that the adult household member signing the application does

not have a social security number. We will use your information to determine if your child is eligible for

free or reduced price meals, and for administration and enforcement of the lunch and breakfast programs.

We MAY share your eligibility information with education, health, and nutrition programs to help them

evaluate, fund, or determine benefits for their programs, auditors for program reviews, and law

enforcement officials to help them look into violations of program rules.

Non-discrimination Statement: The U.S. Department of Agriculture (USDA) prohibits discrimination

against its customers, employees, and applicants for employment on the bases of race, color, national

origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital

status, familial or parental status, sexual orientation, or all or part of an individual's income is derived

from any public assistance program, or protected genetic information in employment or in any program or

activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs

and/or employment activities.) If you wish to file a Civil Rights program complaint of discrimination,

complete the USDA Program Discrimination Complaint Form, found online at

http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to

request the form. You may also write a letter containing all of the information requested in the form. Send

your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office

of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442

or e-mail at [email protected]. Individuals who are deaf, hard of hearing, or have speech

disabilities may contact USDA through the Federal Relay Service at (800) 877-8339 or (800) 845-6136 (in

Spanish). USDA is an equal opportunity provider and employer.

http://coloradopeak.force.com/

http://www.ascr.usda.gov/complaint_filing_cust.html

mailto:[email protected]

4

APPLICATION INSTRUCTIONS

FOR ALL OTHER HOUSEHOLDS, INCLUDING WIC AND HOUSEHOLDS THAT HAVE FOSTER CHILD(REN) LIVING WITH

THEM ALONG WITH NON-FOSTER CHILD(REN), FOLLOW THESE INSTRUCTIONS:

Part 1: List each child’s name, school, and grade. If the child is a foster child, check the foster box. For all students listed, if NO

INCOME, you must check the no income box.

Part 2: Skip this part.


Part 4: Follow these instructions to report all household income. Income can be from the previous month, this month, or your

projected income for next month.

Column 1–Name: List the first and last name of each person living in your household, related or not (such as grandparents,

other relatives, or friends). You must include yourself and all children living with you not listed in Part 1 and students that

have income. Attach another sheet of paper if you need to.

Column 2–Check if no income: If the person does not have any income, check the box.

Column 3–6 Gross income and how often it was received: Next to each person’s name, list each type of income received

and how often it was received.

Earnings from work: example: If you are paid $500.00 bi-weekly, please record $500.00 in the income blank and

mark the bi-weekly check box. Gross income is the amount earned before taxes and other deductions.

Additional Income Sources: List the total amount each person received from all other sources. For example: If you

receive $500.00 monthly for child support, please record $500.00 in the income blank and mark the monthly check

box.

Other Income: Report net income for self-owned business, farm, or rental income. Next to the amount, check how

often the person receives it. If you are in the Military Housing Privatization Initiative, do not include this housing

allowance.

Part 5: If you do not want your information shared with Medicaid or SCHIP, check this box.

Part 6: An adult household member must sign the form and provide the last four digits of his or her Social Security Number or mark

the box if he or she does not have one.

Earnings from Work Wages/salaries/tips Strike benefits Unemployment Compensation Worker’s Compensation Net income from self- owned business or farm

Welfare/Child Support/Alimony Public assistance payments Welfare payments Alimony Child support payments

Pensions/Retirement/ Social Security/SSI/VA Benefits Pensions Supplemental Security Income Retirement income Veteran’s benefits Social Security

Other Income Disability benefits Cash withdrawn from savings Interest/Dividends Income from Estates/Trusts/ Investments Regular contributions from people not living in the household Net royalties/annuities/ rental income Any other income

INCOME TO REPORT:

IF YOUR HOUSEHOLD RECEIVES BENEFITS FROM SNAP (SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM) OR

FDPIR (FOOD DISTRIBUTION PROGRAM ON INDIAN RESERVATIONS), FOLLOW THESE INSTRUCTIONS:

Part 1: List all students; indicate school and grade for each student.

Part 2: List the name of the household member receiving the benefit, and list the case number.




Part 6: Sign the form. The last four digits of the social security number are NOT required.

IF YOU ARE APPLYING FOR A FOSTER CHILD OR MULTIPLE FOSTER CHILDREN ONLY FOLLOW THESE INSTRUCTIONS:

Part 1: List all students; indicate school and grade for each student. Check the foster check box for each foster child.






IF YOU ARE APPLYING FOR A HEAD START, MIGRANT, HOMELESS, OR RUNAWAY CHILD, FOLLOW THESE

INSTRUCTIONS:

Part 1: List all students; indicate school and grade for each student. Indicate if the student is Head Start, Homeless, Migrant or

Runaway.


Part 3: Call Jim Taylor (LPSD Registrar) at 719-488-4700. Part 4: Skip this part.



5

2015-2016Application for Free and Reduced Price School Meals (This form may be used only if participating in the federal Child Nutrition programs)

Last Name(s) of Family Mailing Address, City, Zip Code Telephone Number

INSTRUCTIONS: Using the instruction sheet provided, complete the application, sign your name, and return application to school.

Part 1. Student Information. List all students attending school in the district; provide school and grade information. Check the foster child check box for all students that are the legal responsibility of a welfare agency or court. If the student has NO INCOME, you MUST check the No Income box.

If the student has income please add the student to the household section below and provide income information.

HDS: Head Start; H: Homeless; M: Migrant; R: Runaway

Foster Child

No Income

Student Name: Last, First School Grade HDS H M R

Part 4. List all household members not listed above AND students with income.

List all current gross income, and check how often it was received.

Name: Last, First No

Income

Earnings from work before deductions, or unemployment

Welfare, child support, alimony

Pensions, retirement, Social Security, SSI, VA

benefits Other

monthly bi-weekly

$ . weekly 2x/month monthly bi-weekly $ . weekly 2x/month

monthly bi-weekly $ . weekly 2x/month


monthly bi-weekly




monthly bi-weekly




monthly bi-weekly




monthly bi-weekly




monthly bi-weekly




monthly bi-weekly




monthly bi-weekly




Part 3. If any of the students you are applying for are homeless, migrant, or a

runaway, please call [your school, homeless liaison, migrant coordinator at #].

To be eligible for meal benefits as soon as possible please continue to

complete this application.

Part 6: Signature and Last Four Digits of Social Security Number: An adult household member must sign the application. If Part 4 is completed, the adult signing the form must also list the last four digits of his or her Social Security Number or mark the “I do not have a Social Security Number” box. Social Security Number (Last 4 digits only): XXX - XX - ___ ___ ___ ___ I do not have a Social Security Number

I certify (promise) that all information on this application is true and that all income is reported. I understand that the school will get federal funds based on the information I give. I understand that school officials may verify (check) the information. I understand that if I purposely give false information, my children may lose meal benefits, and I may be prosecuted. I understand my child’s eligibility status may be shared as allowed by law. Sign here: X Date:

Part 2. Supplemental Nutrition Assistance

Program (SNAP) /Food Distribution

Program on Indian Reservations (FDPIR):

Provide the name and case number for the

person who receives benefits.

(Enter information and skip to part 5)

Name:

Case Number:

***************DO NOT WRITE BELOW THIS LINE. DISTRICT USE ONLY***************

Part 3. Other Source Eligibility: If any

child you are applying for is HEAD START,

HOMELESS, MIGRANT, OR

RUNAWAY, check the appropriate box to

the left and call Jim Taylor (LPSD

Registrar) at 719-488-4700.

Part 5. MEDICAID AND/OR STATE

CHILDREN’S HEALTH INSURANCE

PROGRAM (SCHIP)

The information provided in the application

may be shared with Medicaid or SCHIP

offices to seek enrollment of children into the

above programs. You are not required to

consent to the disclosure of this information;

this will not affect your student(s)’ eligibility

for school meals.

Your information WILL be shared unless

you check the box below.

Please do NOT share my

information with the Medicaid

or SCHIP offices.

Annual Income Conversion: Weekly x 52; Bi-Weekly x 26; 2 Times per Month x 24; Monthly x 12

Total Income: Per Week, Bi-Weekly, 2x/Month, Month, Year Household size: Eligibility: Free Reduced: Denied:

Income Categorically Eligible App Num.: Determining Official’s Signature: Date: Withdrawn Date:

6

INSTRUCTIONS FOR 2015-16 INFORMATION RELEASE FORM The attached 2015-16 Information Release Form is used to indicate whether you want the information on your Free and Reduced Price School Meals application to be shared with other programs, including the waiver of required school and bus fees. Please read the form carefully and follow these instructions:

Check the NO box if you do NOT want any of the Free & Reduced information you provided to be shared. NOTE: This includes waiver of fees; if you check NO, you indicate that you understand that all required school fees including bus fees will be charged for your student(s).

Check the first YES box if you DO want your information shared with school officials to consider waiver of required school fees, including bus fees.

Check the second YES box if you DO want your information shared with school officials for

additional student support services.

Check the third YES box if you DO want your information shared with school officials for optional student programs, defined as athletics and extracurricular activities.

Please be sure to include the name of all students to which this information applies.

Sign and date the form, and return to your child’s school or to the District Administration office.

NOTE: If this form is NOT returned, no information will be shared with any other programs and required fees will NOT be waived.

7

2015-2016 INFORMATION RELEASE

Dear Parent/Guardian:

To save you time and effort, the information you gave on your Free and Reduced Price School Meals

Application may be shared with other programs for which your children may qualify. For the

following programs, we must have your permission to share your information. Sending or not

sending in this form will not change whether your children receive free or reduced price meals.

No! I DO NOT want information from my Free and Reduced Price School Meals Application

shared with any of these programs.

If you checked no, stop here. You do not have to complete or send in this form. Your information will

not be shared.

Yes! I DO want school officials to share information from my Free and Reduced Price School

Meals Application for fee waiver consideration of required fees, such as bus fees, technology

and consumable materials.


Meals Application for additional student support services, if applicable.


Meals Application for optional student opportunities, including athletics and extracurricular

activities such as field trips.

If you checked yes to any or all of the boxes above, fill out the information below. Your information

will be shared only with the programs you checked, and the information will not be shared by the

receiving program with anyone else.

Child’s Name: _____________________________ School: ___________________________






Signature of Parent/Guardian: __________________________________ Date: _________________

Printed Name: _____________________________________________________________________

Address: _________________________________________________________________________

For more information, you may call your school secretary or the District Registrar at 719-488-4700.

Return this form to:

Lewis-Palmer School District Nutrition Services, 1300 Higby Rd, Monument, CO, 80132

or to the secretary of your school who will forward the application to Nutrition Services.

LEWIS-PALMER ATHLETIC PASSES

2015/2016 School Year

These passes will be good for all regular season athletic events, with the exclusion of

Gymnastics, Ice Hockey, and Swimming. The pass will not be accepted at CHSAA/post-

season events. Palmer-Ridge passes will not be accepted at Lewis-Palmer athletic events,

nor will Lewis-Palmer passes be accepted at Palmer Ridge athletic events. Passes from both

schools will be accepted in the following District CO-OP Sports: Boys/Girls Lacrosse and

Field Hockey.

ATHLETIC PASS USER AGREEMENT *By purchasing and using this pass the holder/user agrees to abide by the code-of-conduct as outlined in the

athletic handbook and school district polices. Should the user engage in any negative behaviors as deemed by

the Athletic Director or school personnel, he/she may be asked to leave the contest and the athletic pass may

be revoked.

***FULL YEAR ATHLETIC PASSES***

____Adult $70 ____LPHS Student/Senior(60+) $55 ____Child (Grades K-8) $45

LPHS STUDENT NAME:______________________________

Adult/Child/Senior(60+) Passes: _______________________Pass #_____

_______________________Pass #_____

_______________________Pass #_____

_______________________Pass #_____

Total Due $___________ Phone Number:___________Check #__________

NO REFUNDS GIVEN ON ATHLETIC PASSES

F15USPPS © 2015 Lifetouch National School Studios Inc.

VISIT: VISITA:

INSTRUCTIONS: INSTRUCCIONES:

School Portraits

Picture Day is coming! ¡Ya llega el Día de la Foto!

shareable image download with any online package purchase.

Descarga gratis de la imagen para compartir, con cualquier compra del paquete por internet. Código del cupón: SHARE | Mira los detalles en lifetouchdeals.com/share

FREECoupon code: SHARE | See details at lifetouchdeals.com/share

Customize each sheet of your package with different portrait looks at

Personaliza cada hoja de tu paquete con diferentes estilos de retrato en MYLIFETOUCH.COM

ENTER your Picture Day ID:INGRESA tu identificación del día de la foto:

ORDER your perfect package—and don’t worry about returning anything on Picture Day!ENCARGA tu paquete perfecto, ¡y no te preocupes por devolver nada el Día de la Foto!

PORTRAIT LOOKS (POSE + BACKGROUND)ESTILOS DE RETRATO (POSE + FONDO)

LOOK CODE

1

2

3

1 2 3

4 5 6

7 8

More choices at Más opciones en MYLIFETOUCH.COM

Lewis-Palmer High School During Registration Days

CG315148Y0

Questions? Please call 1-866-955-8342 or email [email protected]. A todos los alumnos se les tomarán fotografías para propósitos escolares.

https://my.lifetouch.com/mylifetouch/pictureDayId/CG315148Y0

https://my.lifetouch.com/mylifetouch/pictureDayId/CG315148Y0

ZPass Application for Transportation Bus Service For new transportation students only. If your child already has a LPSD-issued ZPass, this form is not required.

Admin Use Only: F&R ____ IEP____ PrePay____ KHD____ Cash____ Check # _______ Credit ____ Amount ________ Date_________

LPSD-38 * PO Box 40 * Monument, CO 80132 * Phone 719-488-4700 * Fax 719-488-4704 * Email: [email protected]

If your student is eligible for transportation, please complete and return this application with payment to the LPSD Administration Office (Attn: ZPass) at the address above. If you will be paying by credit card, you may submit this form electronically or by fax, and then log into the Infinite Campus Parent Portal and follow the Transportation links to make your online credit card payment. Once the application is processed, a ZPass will be issued to your child(ren) prior to the start of school. Please select one or more of the following options:

I’ll purchase the annual pre-paid bus pass for $150 per student ($75 if my child is a half-day Kindergartner), $450 family max.

I’ll pay the initial bus fee deposit of $25 per student which will be applied to each student’s first 50 rides.

My payments will be reflected online via credit card – I will log into the Infinite Campus Parent Portal to make the payment.

My family will be covered by Free and Reduced Lunch and I request a waiver of transportation fees. Note: If you qualify for Free & Reduced Lunch, please complete and submit your Application for Free & Reduced Price School Meals as soon as possible. Remember to give your permission on the reverse of that application to use the information to waive bus transportation fees.

My student has an Individual Education Plan and uses specialized transportation which is provided as a related service (no fee).

My student resides outside the transport boundary for his or her school, but I’m requesting use of transportation services on a space available basis (Authorization for Transportation for Non-Transport Area Students is required, see Transportation website).

Student’s Last Name Student’s First Name School Grade Amount Paid

Total Payment

Parent/Guardian’s Name(s)

Mailing Address

Student Address for Pick-up/Drop-off

Anticipated first day of Transportation Primary Phone(s)

Special Circumstances

I do not have email access. Please contact me via a paper statement to be mailed to my mailing address listed above.

Please initial below to indicate that you have read and understand each item listed. Each item must be initialed.

1. The District may cancel or deny my child’s eligibility under this program for any misuse or misrepresentation of any facts or circumstances connected with participation in its benefits. The District may also deny eligibility due to failure to observe bus conduct rules.

2. Consequences for failure to pay transportation fees may result in loss of optional school privileges and withholding of official records.

3. I understand the cost of busing for field trips, band, choir and other school activities is billed separately from the ZPass.

4. I understand my account will be billed for a replacement ZPass in the amount of $5 for the first card, and increasing by $5 for each subsequent card. Further, I understand that if my child rides and does not use a ZPass, manual entries will be billed to my account. After three school days of manual entries, I will be billed for a replacement ZPass, as all students riding the bus must use a ZPass.

My signature indicates that I have read and understand all the above terms of the Application for Transportation Bus Service.

Signature By checking this box I am electronically signing this document and I assert I am the person named on the right.

Printed Name (electronic submission) or Signature Date

Please enclose a check or money order payable to Lewis-Palmer School District. You may combine bus fee payments on one check. If you are applying for Free & Reduced Lunch or will be paying by credit card, you may save the form and email to [email protected]

Take advantage of this AUGUST EARLY BIRD SPECIAL. Pre-order your 2016 Lewis-Palmer Westwind FULL COLOR yearbook for only $80. This price is only available through August 31. *Payment options available upon request.

Amount Paid: $________________________ Date Rec’d______________________

Please check: Receipt #_______________________ Cash Check #_________________ Rec’d by_______________________

*Books not picked up by August of the following school year will be resold without refund.

Yearbook only $80

Package Option: $90 *Available only 1st semester Yearbook Name Plate

Return this completed order form with payment for the amount shown below to PROCESSING DAY or MRS. HENDRIX (RM 227) by MONDAY, AUGUST 31 (all prices go up SEPTEMBER 1). Please make your check out to LPHS YEARBOOK. *Payment options available upon request.

I want to order: (check one option)

NAME PLATES: Please PRINT your name as you would like it to appear on the first line below. The maximum number of characters you may use is 33 per line, including spaces.

__________________________________________________________________

*Name Plates are only available for sale 1st semester!!!

_______________________________________________________________________

_________________ __________________________________

NAME (PLEASE PRINT)

GRADE STUDENT ID # (if known)

To order your yearbook, please complete the following information:

Electronic Textbook Damage Form 2015-2016

All textbook damage forms will be filled out

electronically this year. Form is web based so it can

be accessed from home or school.

Online forms are due Sept 4, 2015

1. Go to the LIBRARY WEB PAGE @

lphs.lewispalmer.org

2. Under DEPARTMENTS on the left is the

Library Media/Technology link

3. On the Library Web Page scroll down to

the LIBRARY RESOURCE LINKS

4. Find the TEXTBOOK DAMAGE FORM link

5. Open the TEXTBOOK DAMAGE FORM

6. Fill out the form for all issued

textbooks

7. Scroll down to the bottom of the

form and click SUBMIT

8. Once form is submitted, it cannot be

edited. A new form must be submitted

if you need to edit or add to the original

form.