NORTHWEST ARCTIC BOROUGH SCHOOL DISTRICT Ambler · Buckland · Deering · Kiana · Kivalina · Kobuk · Kotzebue · Noatak · Noorvik · Selawik · Shungnak

PO Box 51 · Kotzebue, Alaska 99752 · Phone (907) 442-1800

MISSION: To provide a learning environment that inspires and challenges students and employees to excel VISION: To graduate all students with the knowledge, skills, and attitudes necessary for a successful future

Home School In-District Transfer Enrollment Packet Dear Parents/Guardians: Greetings and welcome to our school! This packet contains the following: Student Registration Please be sure to sign and date this form. Providing the school with emergency contact numbers are especially important. Home School Requirements Form Contract for parents and students that pertain to the Home School program.

Health Care Emergencies Authorization for emergency health care is vital. We may not be able to reach you if your child is ill or injured and needs medical attention. Permission to Publish Permission to publish gives the District permission to share pictures and video of students and their work electronically. (FERPA) Release and Disclosure This form addresses the release of directory information regarding your child. If you give permission to release information, you do not have to complete this form. The Parent/Student Handbook includes additional FERPA (Family Educational Rights and Privacy Act) information form.

Please return all forms to Joe Groves (907-442-1811), thank you and have a great year!

Please turn in to Joe Groves

Phone: 907-442-1811

Email: jgroves@nwarctic.org

NWABSD HOME SCHOOL REGISTRATION FORM

Student’s LEGAL name:

Last First Middle

Date of birth: / / Inupiaq name: Gender: MALE / FEMALE

Last school attended, city, state: Grade level:

Student cell phone: Student email:

Is the student Hispanic or Latino? (please circle): YES / NO Copies on file? Birth Cert Immunizations Please circle the race(s) that you wish to identify (circle all that apply): African American American Indian Alaska Native

Asian Caucasian Native Hawaiian/Pacific Islander

Parent/Guardian signature: Date:

Name of school: NWABSD Home School

Student’s grade level:

First day in school:

One day wait before attending? (circle) Y N

STUDENT INFORMATION

Mailing address: Physical address:

City: State: Zip:

Name Relationship to student Phone number

EMERGENCY CONTACT INFORMATION (LOCAL)

Name Grade Name Grade

|

|

OTHER CHILDREN IN THE HOUSEHOLD

Name:

Relationship to student:

Home phone:

Work phone:

Cell phone:

Email:

Name:

Relationship to student:

Home phone:

Work phone:

Cell phone:

Email:

PARENT/GUARDIAN INFORMATION

Revised on 7/25/2018

NorthwestArcticBoroughSchoolDistrictHomeSchool

REQUIREMENTSFORM

NWABSDHomeSchoolPOBox51|Kotzebue,AK99752(907)442-1811|(Fax)866-929-1167 http://www.nwarctic.org/Domain/1010

Parents Name(s):

Students Name:

The following are requirements of the NWABSD Home School Program. As a NWABSD homeschooling parent, I agree to:

• Turn in work samples by the specified deadlines (see NWABSD Student/Parent Handbook). • Keep NWABSD Home School Coordinator informed as to enrollment status, change of address and / or any

other change of situation. • Follow procedures and policies as outlined in the NWABSD Student/Parent Handbook. • Ensure that if I have a kindergarten enrollee, he/she will turn 5 years old by September 1st. • To be eligible for enrollment, a student must not be 20 years old on or before October 1st. • Special education students are eligible to enroll if it is determined that NWABSD Home School is the least

restrictive environment and the student has not turned 22 years old on or before July 1st. • Apply for reimbursements and / or submit orders only for materials and supplies related to my student’s

NWABSD Home School educational program. • Apply for reimbursements that are not religious or doctrinal in nature. • If my student withdraws from NWABSD Home School or enrolls in another state-funded public/

correspondence school prior to Nov. 1st all reimbursed funding and materials must be returned immediately; after November 1st all textbooks & equipment must be returned.

• Participate in state mandated tests if my child is in the 3rd, 4th, 5th, 6th, 7th, 8th, 9th, or 10th grade. o Testing is the first Tuesday, Wednesday, and Thursday in April. I understand that the consequence

for failure to attend testing is being barred from re-enrollment and my family fund account will be frozen.

• Meet State of Alaska and NWABSD graduation requirements if my high school student plans to graduate from NWABSD Home School.

• Please check one of the below options. If my student is on an IEP, I agree to notify my student’s special ed. teacher and attend an IEP amendment meeting within 10 days of my student’s transfer to the NWABSD Home School. £ Yes £ No

Signature is required - Your signature confirms your acceptance to all of the above requirements.

Parent / Guardian Date

Student Date

NOTE: Failure to comply with any of the above requirements may result in the involuntary withdrawal of your student from NWABSD Home School.

NORTHWEST ARCTIC BOROUGH SCHOOL DISTRICT Ambler · Buckland · Deering · Kiana · Kivalina · Kobuk · Kotzebue · Noatak · Noorvik · Selawik · Shungnak

PO Box 51 · Kotzebue, Alaska 99752 · Phone (907) 442-1800

MISSION: To provide a learning environment that inspires and challenges students and employees to excel VISION: To graduate all students with the knowledge, skills, and attitudes necessary for a successful future

HEALTH CARE EMERGENCIES

Parents/Guardians: If an accident or illness occurs, the Northwest Arctic Borough School District will attempt to notify the parent/guardian. If we cannot reach you, we will attempt to notify the alternate emergency contact that you provide. However, please complete the following Authorization for Emergency Medical Treatment. This authorization can be used to obtain emergency medical care for your child in the event you cannot be reached.

AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT

I, ________________________________, parent/guardian of ____________________________, consent to emergency transportation, medical treatment, care or hospitalization as deemed necessary for the welfare of my son/daughter by the local health care provider, in the event an injury or illness occurs while my son/daughter is at school or a school sponsored activity. I understand that the School District will assume no liability or costs for such emergency transportation and medical treatment.

___________________________________ ________________________ Parent/Guardian Signature Date

Revised: July 2015

Instruction E 6161.5(e)

NORTHWEST ARCTIC BOROUGH SCHOOL DISTRICT Permission to Publish Media Release Form

Dear Parent/Guardian,

As part of your son’s/daughter’s educational program, (s)he will have the opportunity to:

1. Create and publish documents and projects on the internet such as a story, book or poem, a graphic, a science or research project, or a collaborative project with other students locally or regionally and

2. Participate in a wide range of activities such as clubs, school assemblies, sports, performances, academic contests including but not limited to spelling bees, science fair, and Battle of the Books

These are exciting and memorable moments for both your student and school. Student work, photos and video are commonly taken to be used in various forms of media for the purpose of recognizing student achievement and promoting pride in the school district and community.

The Northwest Arctic Borough School District will publish these items only with your written permission.

Without permission, the student cannot appear in any class pictures, team photos, or any other school pride promotions or have any of their work published. Please note that all District students may have their likeness appear in certain school sponsored or approved productions, including broadcasts of sporting events or in group photographs.

Thank you for your support.

Student Name:

Please initial one of the options below:

______ I GRANT NWABSD permission to publish my child’s name, student work, photographs, voice and/or video recordings in Northwest Arctic Borough School District print media, social media, website and the use, editing and release to local newspapers (i.e. The Arctic Sounder) and radio stations (i.e. KOTZ Radio).

______ I DO NOT GRANT NWABSD permission to publish my child’s name, student work, photographs, voice and/or video recordings in Northwest Arctic Borough School District print media, social media, website and the use, editing and release to local newspapers (i.e. The Arctic Sounder) and radio stations (i.e. KOTZ Radio).

Parent/Guardian Signature Date

MISSION: To provide a learning environment that inspires and challenges students and employees to excel VISION: To graduate all students with the knowledge, skills, and attitudes necessary for a successful future

NWABSD Technology Department - Updated July 3, 2018

NORTHWEST ARCTIC BOROUGH SCHOOL DISTRICT P.O. BOX 51 KOTZEBUE, ALASKA 99752 TELEPHONE (907) 442-1800 ♦ Fax (907) 442-2392

RELEASE AND DISCLOSURE

(Directory Information Board Policy 5125.1)

The Family Educational Rights and Privacy Act (FERPA), a federal law, requires the District, with certain exceptions, to obtain your consent prior to disclosing personal information from your student’s education records. The law recognizes, though, that schools often desire to publish student information, for example, to recognize students through awards or athletic programs. Additionally, outside organizations such as colleges, legislators, the military, and vendors for items such as photographs or class rings, often seek contact information for students. To meet this need, FERPA allows the District to designate as “directory information” any personally identifiable information in a student’s educational records that would not generally be considered harmful or an invasion of privacy if disclosed. School officials may release directory information about a student without first obtaining parental consent, unless you object by returning this form.

The District has identified the following information as directory information: student name, address, telephone number, date and place of birth, major field of study, dates of attendance, degrees and awards received, name of school most recently attended, participation in officially recognized activities and sports, and height and weight of athletic team members. This list is found at Northwest Arctic Borough School District Board Policy, Article 5, section 5125.1. A copy of this policy is available for review in the office of all our schools, or on the District’s website (www.nwarctic.org).

In two instances, the District is required by law to release certain contact information regarding junior and senior high school students, unless you object. First, the District is required to provide to the University of Alaska the names and addresses of those students eligible for UA scholarship programs. Second, upon receiving a request from military recruiters and/or institutions of higher learning, the District must provide names, addresses, and telephone listings.

If you do not want the District to disclose directory information from your student’s education records during this school year, you must notify the District, in writing, by returning this form. If you have no objections to the release of directory information, you do not need to take any action.

Thank you for your cooperation.

I Do NOT give permission for the release of directory information regarding my child. (For parents of junior and senior high school students, this form also prevents release of phone numbers and other contact information to military recruiters and/or postsecondary educational institutions.)

Student Name_______________________________________

Teacher__________________________________________

Date___________________________________________

Parent/Guardian Signature__________________________________

Revised: July 2016