Common Forms and Annual Notifications

Forms

Health Forms
  • Health exam form for grade K-12 and sportsHA1/HPE5 (BOE7512F) required for students entering grades kindergarten, 2nd, 4th, 7th and 10th and all new students (the same form is used for secondary students interested in participating in sports)
  • Permission to administer medication in school – HM2 (BOE7513F) State Regulation prohibits the administration of any medication without a physician’s order and parent’s written permission. ALL medications must be in the original container
  • Dental Health Certificates (BOE7512F.1) In accordance with NYS Public Health Amendment A00581 to State Law 2903 effective 9/1/08 students enrolling in kindergarten, second, fourth, seventh and tenth grades are requested to present a dental health certificate. Such dental health certificate must contain a report of a comprehensive dental examination performed on the student. If you have questions about the above request please call Student Services at 881-0600, ext. 68302.
  • Permission for use of Sunscreen HM2A (BOE 7513F.1) NYS has changed the requirements for sunscreen use in schools. Prior to this school year, sunscreen required a written doctor’s order for use in school. As of this year, students who are self-directed (can apply sunscreen themselves, know why they need sunscreen & understand that they cannot share it with others) are now allowed to carry and use sunscreen with written parent permission on file in the Health Office at school. The doctor’s order requirement remains for those students who are considered non self-directed (who do not meet the above criteria.)
Interscholastic athletic forms
Transportation Forms
Registration
  • Student Registration Form (BOE 7130F) – This form will need to be completed and brought with you to your registration appointment.
  • Transfer of Records (BOE 7130F.5) This form will need to be filled in with the child’s most recent school information (NOT Shenendehowa’s school information). Please bring the completed form with you to your registration appointment and fill out one form per child being registered.
  • Student Residency Questionnaire (BOE 7130F.1) – Please bring the completed form with you to your registration appointment and fill out one form per child being registered.
  • Home Language Questionnaire (BOE 7130F.6)- Please bring the completed form with you to your registration appointment and fill out one form per child being registered.
  • Health Summary (BOE 7130F.4) This form will need to be completed and brought with you to your registration appointment. Please fill out one form per child being registered.
Other Forms
  • Free and reduced lunch form (BOE 5660F)
  • Permission to go on a field trip (BOE 8460)
  • Permission to bring a pet to school (BOE 8335F)
  • Pesticide Notification Form (BOE 3310) — The Shenendehowa Central Schools is required to maintain a list of persons in parental relation, faculty, and staff who wish to receive 48-hour prior written notification of certain pesticide applications.

Annual Notifications

Pesticides

New York State Education Law Section 409-H and State Education Department Commissioner’s Regulation 155.24, effective July 1, 2001, requires all public and nonpublic elementary and secondary schools to provide written notification to all persons in parental relation, faculty, and staff regarding the potential use of pesticides periodically throughout the school year. The Shenendehowa Central Schools is required to maintain a list of persons in parental relation, faculty, and staff who wish to receive 48-hour prior written notification of certain pesticide applications.  Pesticide Notification Form (BOE 5635F) explaining the procedure.

Fire Inspection Report

Notice is hereby given that the annual inspection for the 2016-17 school year of the Shenendehowa Central School District buildings for fire hazards which might endanger the lives of students, teachers, employees therein; has been completed and the report thereof is available at the office of Jay Tourtellot, Director of Operations, at 946 Route 146, Clifton Park, NY for inspection by all interested persons.

Asbestos Management Plan

As required by the EPA since 1989, the Shenendehowa Central School District has kept Asbestos Management Plans for the district. This notification must be given annually, stating that the Asbestos Management Plans are on file in each Principal’s office and collectively at the Facilities & Operations Office. These records are available for review during normal business hours. As required, periodic surveillances are conducted every six months. The next three year re-inspection is required to be performed by July 9, 2019. Currently, there are no projects scheduled that will disturb asbestos containing building material:
For more information, contact Kenneth Patenaude, LEA Designee at 881-0300.

Dispensing Medication in School

State Regulation prohibits the administration of any medication without a physician’s order and parent’s written permission. ALL medications must be in the original container

Initial Parents Bill of Rights for Data Privacy and Security (Education Law Section 2-d, effective July 29, 2014)
  • A student’s personally identifiable information cannot be sold or released for any commercial purposes.
  • Parents shall have the right to inspect and review the complete contents of their child’s education record.
  • State and Federal laws protect the confidentiality of personally identifiable information and safeguards associated with industry standards and best practices, including but not limited to, encryption, firewalls and password protection, must be in place when data is stored or transferred.
  • A complete list of all student data elements collected by the State is available for public review at NYSED or by writing to the Chief Privacy Officer at NYSED.
  • Parents have the right to have complaints about possible breaches of student data addressed. Complaints should be directed to the Superintendent of Schools in the District.
  • This bill of rights is subject to change based on regulations of the commissioner of education and the NYSED chief privacy officer.
Family Educational Rights and Privacy Act (FERPA)

FERPA provides the following rights to parents of students enrolled in district schools (these rights transfer from the parent to the student once he/she turns 18 or is attending college):

  1. You may inspect and review your child’s education records, by contacting the school principal, who will arrange for you to inspect them within 45 days. You may obtain a copy of any record by giving the principal a request that specifically identifies the record you want copied. The copies will be made within a reasonable time after your request is received; you may be charged .25 cents per page for the copies.
  2. You may seek amendment of your child’s records if you believe they are inaccurate or in violation of the student’s privacy or other rights, by contacting the district records access officer. You should tell the officer what specific portions of your child’s records you believe are inaccurate, misleading or a violation of privacy rights, and how you want them amended. If the officer determines that the record should not be amended, you have the right to a hearing to review that determination; the process for requesting a hearing will be explained to you at the time of the officer’s determination.
  3. The district cannot generally disclose personally identifiable information contained in your child’s records to anyone outside the district without your consent. The district will disclose your child’s records to school officials only if they are providing educational services to your child, or otherwise need access to the information in those records in order to perform the work of the district. School officials include: administrators, teachers, and support staff employed by the district; Board of Education members; a parent or student serving on a district body such as the Committee on Special Education or the Student Senate; or any individual or company such as a law firm, medical consultant or specialist which contracts to provide services to the district or its students. The district will forward your child’s records to other educational agencies or institutions, including other school districts, in which your child seeks or intends to enroll, or from which your child is receiving services, upon the request of the agency or institution. You may request a copy of any record which has been sent to such an agency or institution, and you may seek amendment of any such record as described in Section 2 of this Notice.
  4. If you believe the school district has not complied fully with FERPA or its regulations, you may file a complaint with the Family Policy Compliance Office, U.S. Department of Education, Washington D.C., 20202-4605. Procedures for filing this complaint can be obtained from the Records Access Officer.
  5. You have the right to object to release of information concerning your child to military recruiters or institutions of higher education. Federal Law requires the district to give the name, address and telephone number of each high school student to these organizations on request. If you object to this, you should inform the Records Access Officer, in writing, on or before September 1 in any school year. If your objection is received after Sept. 1, it will become effective the next time, thereafter, the district compiles the information for that purpose.

    The district’s Records Access Officer can be reached at 5 Chelsea Place, Clifton Park, NY 12065, phone number 881-0611.

Records Access/Freedom of Information

Access to records of the District shall be consistent with the rules and regulations established by the State Committee on Open Government and shall comply with all the requirements of the New York State Public Officers Law Section 87. The Records Access Officer is Rebecca Carman. She has the duty of coordinating the School District’s response to public request for access to records and making records available pursuant to the Freedom of Information Law.
Photocopies of any records shall be made available upon payment. For more information and fees see BOE policy 3310.

Public Relations Use of Student Data/Photos

From time to time, student photos/information (name, grade level, teacher, school, honor roll, awards, art work, etc.) is released for use in district publications, the district’s website or the media depicting the activities of the Shenendehowa School District. If you object to the release of this type of information, you should inform the principal at your child’s school, in writing, annually.

Disclosure of Information to Military Recruiters

Pursuant to the federal No Child Left Behind Act, the school district must disclose to military recruiters and institutions of higher learning, upon request, the names, addresses and telephone numbers of our high school students. Parents have the right to request in writing to their child’s principal that the district not release this information if it is requested.

Title IX

Shenendehowa does not discriminate on the basis of race, color, national origin, creed, sex, and age or handicap as defined by law, and is in compliance with Title IV of the Education Amendments of 1972 and with Section 504 of the Rehabilitation Act of 1973. The compliance officer for Title IX and Section 504 is the assistant superintendent for human resources, (518)881-0600.