Académique Documents
Professionnel Documents
Culture Documents
2018-2019
Student: _____________________________________________
School: ______________________________________________ Grade: ______
All Parents\Guardians and students in the Lauderdale County School System must acknowledge by
signing this form that they have access to, and responsibility for the following items:
• An awareness and understanding of the contents of the School System Parent\Student
Handbook found online at www.lcschools.org.
• An awareness and understanding of all local school policies.
• An awareness that parents\guardians may view their child’s student information online.
Information such as grades, schedule, and attendance may be viewed by obtaining a password
from the local school.
• That permission is given for the student to participate in the system-wide 1 to 1 mobile device
program including having access to networked educational computer applications.
• That parent\guardians are financially responsible for lost\damaged textbooks, library books,
school equipment and mobile devices.
• That permission is given to use the child’s photograph, video image, and photographic likeness
for school purposes including videotapes, yearbook, social media and advertisements. (You
may send a letter to the school principal if you do not want your child photographed for school
purposes).
This questionnaire is intended to address the McKinney-Vento Act 42 U.S.C. 11435. The answers to
this residency information help determine services the student may be eligible to receive. Information
provided on this form is confidential.
Check the following living situation that applies to the student named above:
_____ Living with friends or relatives temporarily due to loss of housing or economic
hardship
______________________________
Printed name of parent/guardian/unaccompanied youth
* Please
return this completed form to your school or the Lauderdale County Board of Education office located at 355
County Road 61 Florence, Alabama 35634, Attention: Homeless Coordinator.
Address: ____________________________________________________________________________________________________
3. What language is spoken by you and your family most of the time at home? ___________________________________
6. Is your child’s first-learned or home language anything other than English? ❏ Yes ❏ No
If you responded “Yes” to question number 6 above, please answer the following questions:
7. What language did your child learn when he/she first began to talk? ___________________________________
8. What language does your child most frequently speak at home? ___________________________________
9. What language do you most frequently speak to your child? (Father) ___________________________________
(Mother) ___________________________________
10. Please describe the language understood by your child. (Check only one)
A. ❏ Understands only the home language and no English.
B. ❏ Understands mostly the home language and some English.
C. ❏ Understands the home language and English equally.
D. ❏ Understands mostly English and some of the home language.
E. ❏ Understands only English.
______________________________________________ ___________________________________
Parent or Guardian's Signature Date
To Parent or Guardian:
The purpose of this form is to provide the school nurse with additional information regarding your child's health needs The school nurse may contact you for
further information The information requested is essential for the school nurse to meet the health needs of your child
Address (Street)
Home Telephone Number: Cell Phone Number: Additional Phone Number: Grade Teacher/Homeroom
Transportation
D Bus Rider Bus Number: D Car Rider D Special Needs Bus D After School
Place your child receives health care: Your child's Insurance Information: Place your child receives dental care: