Crossroads Alternative School Application

Crossroads Alternative School Application

MORGAN COUNTY

ALTERNATIVE EDUCATION PROGRAM

APPLICATION

2016-17

Date

I. Student Name:

Last) (First) (Middle Initial)

Address ______

(Street) (Apt #) (City/State) (Zip)

Home Phone: ______DOB: ______

SSN:______School Last Attended ______

II. Parent/Guardian Name ______

(Last) (First)

Address ______

(Street) (Apt#) (City/State) (Zip)

*Email Address ______Cell Phone ______

Home Phone ______Work Phone ______

Name of Employer ______

Father/Mother/Guardian (If different from above)

Last Name: First Name

Address ______

(Street) (Apt#) (City/State) (Zip)

*Email Address ______Cell Phone ______

Home Phone ______Work Phone ______

Name of Employer ______

What relationship is the above person to the student?

Who has custody of student?

III. Students and Parent/Guardians,

Please carefully read the following information and sign your names whereindicated.

I, ______am interested in enrolling as a student in the Morgan County Alternative Education Program. I have read and understood all the school guidelines and dress code policies as they have been explained to me by the director. I agree I will abide by these policies, as they have been explained to me. I also understand to remain in good standing while enrolled in the AEP, I must accomplish the following:

  1. Establish and maintain regular and punctual daily attendance.
  2. Complete all academic assignments given by AEP teachers
  3. Accept responsibility for my actions and conduct myself in a school appropriate (proper) manner at all times while at school or when using school transportation.
  4. Follow all school rules that are in place for the AEP.

I also understand failure to adhere to any of the above requirements will result in disciplinary action which may include long-term suspension or expulsion from the Morgan County School System.

______

(Parent/Guardian Signature) (Date)

______

(Student Signature) (Date)

IV. Student Emergency Information

Emergency contact person other than parent:

Relationship to student: Telephone Number

Can student take Tylenol and receive minor First Aid treatment at school? Yes No

V. Health Information

Medical Conditions (Illnesses, allergies, etc) and any other problems of which we should be aware:

Medications (Any medicine that must be taken for ongoing medical condition):

In the unlikely event of an evacuation of the school, would your child be physically able to walk ½ mile to a safe location? Yes No (If no, please explain on the back)

Health Insurance: None Peachcare Medicaid Other

Please initial the permissions for which you are signing:

My child may have Benadryl for insect or food allergies.

In the event I or the emergency contact cannot be reached, I authorize the school to take

appropriate emergency medical actions to safeguard the health of my childin including

transport by ambulance.

The school nurse has my permission to contact my child’s healthcare provider for further

health information.

______My child has permission to leave school for field trip purposes and travel on a Morgan County School bus.

Please pay special attention to rules in BOLD. They are new or revised for the 2016-17 school year.

Dress Code Policy:

Jackets:

  1. No jackets that have a hood are allowed to be worn once students are checked in and inside of the building. Other jackets without a hood are permitted to allow kids to be comfortable in the building. The uniform must be appropriate under the jacket. If you feel like you may get cold during the day, you should wear a long sleeve white t-shirt under your collared shirt.

Shirts:

  1. All students must wear either a BLACK polo STYLE golf shirt or a long sleeve/short sleeve BLACK buttoned down shirt.
  2. Shirts must be tucked inside the waistband before being checked in at the door and remain formal throughout the day-until PE.
  3. White long sleeve t-shirts may be worn under outer shirt.

Pants:

  1. All students must wear plain Khakis. Only khaki will be accepted.
  2. Pants must be appropriate size and length. No shorts permitted except during PE and they too must be length and size appropriate.
  3. Pants must not have holes or ripped off belt loops.
  4. Pants must be worn at the waist.
  5. Belts must be worn if the pants have belt loops.
  6. Pants may not be tucked into socks or pegged at the ankle.

Shoes:

  1. No open-toed/backed shoes or bedroom slippers may be worn.
  2. Shoes with eyeholes or Velcro must be laced or fastened.

Bookbags:

Bookbags are not allowed at the Alternative School. Please do not bring a book bag to school with you. If you do, it will be taken up and not returned until the parent comes to pick it up.

Miscellaneous:

  • Males may NOT wear earrings to school.
  • All students are permitted to wear one necklace, bracelet, watch, etc.
  • Hats must be turned in with cell phones.
  • Students are not allowed to wear hooded sweatshirts or jackets during class. If the jacket or sweatshirt has a hood, it must be taken off. Otherwise jackets and sweatshirts are allowed.
  • Electronic devices such as phones, mp3s, etc. should be turned in at check in to a teacher or administrator. If they are not turned in and the student is caught with the device the following consequences will occur.

1st infraction: Phone taken away and given back at the end of the day

2nd infraction: Phone taken and given back at the end of the following school day

3rd infraction: Phone taken and parent/guardian must come pick up the following day. Also, a one day suspension, and student will not be allowed to bring the device back to school.

I have read and understand the dress policies and agree to follow the above guidelines. As parent/guardian I agree to help my student follow the above guidelines.

VI. General AEPGuidelines

Rule of Thumb-If you follow the tenets of 1. Be a student 2. Be responsible 3. Be respectful, you will not have a problem.

The Following rules have been established to allow all students and staff to constructively maximize the use of school time and provide all students an opportunity to learn in a positive, orderly environment. The violation of any of these guidelines will result in various teacher and administrative actions.

  1. The school day starts at 8:00 every day and the students must be on time.
  2. All directives given to the students will be followed when first issued.
  3. An unopened bottle of water is the only food/beverage that will be allowed through check-in. Any other food, drink or gum will be confiscated and immediately discarded.
  4. The Morgan County Board of Education requires a student to have a minimum of 95% attendance rate. Ten or more unexcused absences will result in the student’s name being placed on a list revoking his/her driving permit/license. A period of absence over five should be covered by a doctor’s note.
  5. It is the student’s responsibility to get make up work from an absence. Any missed work will result in a zero. During a suspension, the teachers will produce a log of all missed activities and work.
  6. There will be no heads down or sleeping during class.
  7. Restroom and water breaks are only permitted with teacher permission. A student may not leave the physical room without teacher consent.
  8. Students are strictly prohibited from any physical contact-i.e. horseplay, aggression, or display of affection.
  9. Computer use is for school assigned purposes only. Any student “surfing” will be disciplined as a computer violation.
  10. Students are expected to make seamless transitions from class to class.
  11. While in class, the students must not disrupt the classroom environment.
  12. All students will follow a “3strike policy” concerning violations. The first and second will result in student-administrative conference and the third will result in various suspensions. However, some incidents will result in more extreme immediate suspensions.

I have read and understand the above rules and consequences. As a student, I agree to follow the guidelines. As a parent, I recognize my student is ultimately responsible for his/her own behavior and agree to aid my student in following the above rules.

______

Parent Signature

______

Student Signature

Administrative Procedures for Successful Completion of the Morgan County AEP.

Please make sure you read and understand this procedure!

The goal for every student enrolled in the alternative school program is to learn the self-control necessary to follow the rules and perform academically in the AEP as a demonstration of his/her ability to follow the rules and perform academically at his/her base school. These skills enable the student and the teacher to achieve the ultimate goal of public schools, successful completion of high school. With those goals in mind, each student must demonstrate his/her progress and achievement in each of the following three areas before he/she is allowed to return to the base school or to be reviewed for early release.

  1. Attendance
  2. Academic achievement
  3. Behavior

The following people are authorized to pick up my child.

Name / Driver’s License Number

Parent Signature

REVISED 7/27/16

Morgan County AEP supply List

2015-16

To be prepared for the first day of class, please bring the following:

(1)3 ring binder

(2)100 sheet packages ruled paper

(1) Package #2 pencils

(1) Package black ink pens

(1) Bottle hand sanitizer

(1)Box Kleenex tissue

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