WELCOME TO THE 2013-2014 SCHOOL YEAR! BACK TO SCHOOL CHECKLIST o Be sure EPS has your current family contact information (update in SchoolView or contact your child’s school). o Attend your school’s Open House/Get Connected Day. o
Check your child’s lunch account.
o Confirm your child’s immunization information is up to date.
MARK YOUR CALENDAR Wednesday, August 14, 2013 Valley View Get Connected Day Enclosed please find important information for all Edina Public Schools (EPS) families pertaining to the upcoming school year. Included you will find information about:
Wednesday, August 21, 2013 South View and Edina High School Get Connected Days
EPS Food and Nutrition Program – overview information as well as instructions and application for free or reduced price meals;
Data Privacy – information on EPS’s Release of Student Information policy and procedures;
Health & Safety Notifications – annual notifications from the EPS Health and Safety Program;
Thursday, August 29, 2013 Concord, Cornelia, Countryside, Highlands, Normandale Open Houses
Student Health Requirements – information on student immunization requirements; and
Tuesday, September 3, 2013 First Day of School: Grades 1-12
Insurance Programs – information on Minnesota Health Care Insurance Programs for students and families.
Additional information about district programs and services can be found inside the 2013-14 Activities Calendar. For information on district policies relevant to student and school expectations, we also encourage you to refer to the 2013-14 Students Rights and Responsibilities Handbook. All of the above materials are available at all EPS schools, as well as online at www.edinaschools.org. Thank you for your partnership in making 2013-14 a great year! Concord Elementary 952-848-4300
Creek Valley Elementary 952-848-3200
South View M.S. 952-848-3700
Cornelia Elementary 952-848-4600
Highlands Elementary 952-848-4500
Valley View M.S. 952-848-3500
Countryside Elementary 952-848-4700
Normandale Elementary 952-848-4100
Edina High School 952-848-3800
Wednesday, August 28, 2013 Creek Valley Open House
Wednesday, September 4, 2013 First Day of School: Kindergarten (AM, PM and K Plus), Early Childhood Special Education (ECSE), and Edina Family Center
Looking for more back to school information and resources? Visit the “Information and Forms” page on your school’s website or visit www.edinaschools.org/parents.
EDUCATIONAL PROGRAMS AND SERVICES The District provides extensive education programs and services to support and challenge all of its students. For details on specific programs or to find the right fit for your child, contact the Welcome Center (952-848-3900), your school office, or visit our website (www.edinaschools.org). ADDITIONAL SCHOOL DISTRICT MAILINGS The school district will be providing additional mailings to families that highlight specific schools, programs and services, including: • Individual school information • Bus transportation requirements and schedules Please check the district’s website for additional information. Also, the district continues to assess more effective and efficient ways to connect with families, and we welcome your input. EMERGENCY SCHOOL CLOSINGS All school closings, due to severe weather or other emergencies, will be shared with families through our school messaging system (School Messenger), via the district’s website (www.edinaschools.org), district social media accounts, and through local media. This applies to unscheduled late starts or early dismissals as well. Families are encouraged to have plans for possible emergency school closings. STUDENT RIGHTS & RESPONSIBILITIES HANDBOOK A safe, secure and welcoming learning environment is essential in helping our students be successful learners. The District has developed comprehensive policies and procedures which define our students’ rights and responsibilities and provide for a positive learning environment. These expectations are outlined in the Students’ Rights and Responsibilities Handbook, which may be reviewed online (www. edinaschools.org/students). Families may also request a copy of the handbook from their school office. Teachers will review the handbook at the beginning of the school year, and parents/guardians are asked to review the handbook with their children. CHEMICAL AND TOBACCO FREE Edina Public Schools’ property, school sites, and school-related activities are chemical and tobacco free.
STUDENT ACTIVITIES Student activities are an integral part of the District’s total educational program. EPS sponsors a variety of activities, which are available to all students at each school site and through community education services. To participate, middle and high school students must meet district eligibility requirements and, if applicable, Minnesota State High School League requirements. Participation fees may be assessed, with scholarships available for eligible students. For more information, contact the Activities Office (952-848-3815). HEALTH PROMOTION AND CARE Good health is important to student learning and to active participation in school. Health services are provided during the instructional day at each school site. Students enrolled in and admitted to Edina Public Schools are required to be in compliance with the Minnesota School Immunization Law. Some students may require prescription and non-prescription medication during the school day. In such cases, medication may only be administered by a licensed school nurse or trained school personnel. For more important health information, visit our website (www.edinaschools.org). MEDICAL, HEALTH AND ACCIDENT INSURANCE The district does not purchase medical, health or accident insurance for your child. If your child has an accident, is ill, or is injured while at school or participating in district-sponsored activities, families will need to access their own insurance plans to cover any associated costs (e.g. medical care, emergency transportation). The District cannot pay these associated costs. Questions about insurance should be directed to Margo Bauck, Director of Business Services (952-848-4916, email@example.com). EMPLOYEE BACKGROUND CHECKS Edina Public Schools places a high priority on ensuring a safe and healthy learning environment for staff and students. This includes requiring that all applicants who have been offered school district positions complete a criminal background check as part of the process for determining employment. The District also requires a criminal background check for all unsupervised volunteers. This process meets the requirements of Minnesota state statutes. Questions about employee background checks should be directed to Gwen Jackson, Director of Human Resources & Operations (952-848-4946, gwejackson@ edinaschools.org).
FAMILY COMMUNICATIONS INFORMATION
Edina Public Schools places a high value on the connections we have within the school, with the home, and throughout the community. We recognize that effective communications are critical to a strong partnership, and we are committed to providing a variety of ways families can communicate and engage with EPS in an effort to nurture and grow these important partnerships. While we remain committed to providing traditional school communications such as the printed calendar and newsletters, we have also turned our attention to a variety of electronic communication tools to reach families in new ways. ONLINE ACCEPTABLE USE PROCEDURES Students can access the world of online resources from their classroom through the Internet. Parents/guardians must approve their child(ren) accessing Internet resources, and students must agree to follow the acceptable use procedures. Consent forms are required for families with students new to the District and for those entering grades 3, 6 and 10. The form is available online (www.edinaschools.org/parents).
SCHOOLVIEW This online tool allows families to access their studentsâ€™ academic progress, keep current on school assignments, tests and other activities, and track student attendance. Accessible either online or via mobile app, families are connected to a wealth of student information that enhances the school-home partnership. To sign up for School View, visit www. edinaschools.org/parents.
ONLINE COMMUNICATIONS ACCESS Through the use of new online technology tools, Edina Public Schools will continue to advance information sharing with families and students. The information shared online will include school communications, student educational progress reports and grades, and district emergency messages. Families who do not have online access should contact their respective schools to ensure they are able to receive this information via alternative means.
SCHOOL MESSENGER This electronic notification system is used by EPS to send instant messages via email or voicemail to all district families and staff. The system is used to communicate emergency information quickly, while also allowing staff to share important information about school and program issues and upcoming events. The School Messenger system is integrated with the districtâ€™s student information system, so be sure your school has your most current contact information.
DISTRICT COMMUNICATIONS Edina Public Schools uses a variety of avenues to connect with families. The District encourages families to contact their teachers and/or schools with questions, concerns, comments or timely topics. Families will receive periodic communications from the District and schools.
EDINA MOBILE APP EPS recently launched a mobile app that provides a one-stop source for parents, staff, students and community. The app provides users with instant access on their smartphone or other mobile device to important school information such as staff directories, school announcements, directions and maps, and lunch menus. The EPS App is free for users and available for download from the app stores on Android and iOS devices.
DISTRICT AND SCHOOL WEBSITES Check out the new www.edinaschools.org! The new website platform provides users with easier access to important district, school, and Community Education Services information and resources. DISTRICT/ ACTIVITIES CALENDAR For the second year in a row, we have streamlined our Activities Calendar. The 2013-14 calendar, which includes highlights of key events, allows the district to maximize its print dollars. Individuals looking for the most accurate and up-to-date activity information are encouraged to access the digital calendar available on the EPS website (www.edinaschools.org). Note that the online calendar also allows users to download school or district activity calendars directly to their own electronic device.
SOCIAL MEDIA Like us on Facebook, follow us on Twitter, watch us on YouTube, view photos on Flickr! Edina Public Schools is committed to communicating and engaging with families wherever they are. Stay tuned throughout the school year as we expand our social media efforts to further engage all stakeholders in the work of EPS. Visit www.edinaschools.org/social to learn more.
FOOD & NUTRITION PROGRAM Edina Public Schools contracts with Sodexo to facilitate its food service program. The EPS Food Service program is part of the National School Nutrition Program, which offers food based combo meals. Combo meals are required to meet specific nutritional guidelines established by the Federal Government. Several different entrees and sides are offered each day for lunch. Breakfast is available at school before the start of classes. Menus are posted on the website and at school. ALL STUDENTS HAVE A LUNCH ACCOUNT. IF YOU DO NOT WANT YOUR STUDENT TO PURCHASE LUNCH, FILL OUT A MEAL RESTRICTION FORM TO CLOSE THEIR ACCOUNT. We will not deny a child a combo meal unless we have a restriction form online. A lunch combo meal is comprised of five components: vegetable, fruit, protein, grain and milk. Students must choose three of these components, and one of the three must be a fruit or vegetable. They may choose up to five different components. If this combination of food is not selected by the student, we can not charge it as a combo meal by federal government regulations. Each item will be charged separately at a la carte prices and if more than five components are taken the additional items are charged a la carte prices. Parents may request restrictions for a combo meal only or limit spending to a dollar amount per day. Families interested in restricting their child’s meal account should complete a “meal account restriction form,” which can be found online at www.edinaschools.org. MEAL PRICES • Breakfast meals - $1.40 • Lunch meals • Elementary combo meal - $2.40 • Secondary combo meals - Daily special combo meal $2.60; Premium combo meal $2.30 . • A la carte items are available in addition to a meal (see www.edinaschools.org for details) FREE AND REDUCED PRICED MEAL PROGRAM Families with limited incomes may qualify for free or reduced-price meals. The cost for reduced priced lunches is $0.40. Reduced-priced breakfasts are served at no charge. To apply for free or reduced-price school meals, complete the enclosed Application for Educational Benefits on the following pages. Note that families must submit a new application each school year. In addition to providing discounted or free meals for qualified students, free/reduced price meal applications are also used to identify activity and other scholarship opportunities for EPS students. In addition, the district receives additional funding and can access grant resources based on the number of free/reduced lunch applications it receives. Applications are available in this handbook, online at www.edinaschools.org, or you may contact the District Nutrition Office at any time during the school year. Completed Application for Educational Benefits should be submitted to: EPS Food & Nutrition Services, Edina High School, 6754 Valley View Road, Edina, MN 55439. MEAL ACCOUNTS AND ONLINE PAYMENTS The district uses an individual meal accounting point of sale system. Each student has their own individual account. Accounts are debit accounts and therefore there must be money in the account in order for the student to use it. Deposits into accounts may be done online though PayPAMS.com, or checks written for a single account may be deposited several ways: 1) students may bring a check with them to lunch and give it to the cashier; 2) checks may be dropped off at the school office or 3) checks may be mailed directly to the District Food Service Office. Checks written for multiple student accounts (i.e. to be split among several accounts) must be sent to the Food Service Office with allocation amounts identified by student name and school. Make checks payable to ISD #273 Nutrition Program, and mail to Food & Nutrition Services, Edina High School, 6754 Valley View Road, Edina, MN 55439 If a student’s meal account holds a negative balance, he/she may either pay with cash or will be provided a bag lunch. If you register on PayPAMS, you may designate to receive low balance notifications via email. For additional questions about account balances or activity, contact the Food Service Office (952-848-3811) if you have questions about an account balance/activity. STUDENT ID AND PERSONAL IDENTIFICATION NUMBERS Elementary and middle school students receive a Personal Identification Number (PIN) at school to access their meal account. The same number is used throughout elementary school. A student receives a new PIN in middle school. Meal account balances transfer from year to year through high school. High school students can present their student ID to the cashier to access their account. QUESTIONS If you have any questions or comments, please contact: Mary Lombardi, RD, LD, MPH (firstname.lastname@example.org, or 952-848-3813) In accordance with federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. To file a complaint of discrimination, write USDA, Director, Office of Adjudication, 1400 Independence Avenue, SW, Washington, D.C. 202509410 or call toll free (866) 632-9992 (Voice). Individuals who are hearing impaired or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339; or (800) 845-6136 (Spanish). USDA is an equal opportunity provider and employer.
FREE/REDUCED-PRICED MEAL INFORMATION FREQUENTLY ASKED QUESTIONS Who can get free or reduced-price meals? Children in households participating in the Supplemental Nutrition Assistance Program (SNAP), Minnesota Family Investment Program (MFIP) or Food Distribution Program on Indian Reservations (FDPIR), and foster children can get free school meals without reporting household income. Also, children can get free or reduced-price school meals if their household income is within the maximum income shown for their household size. Approval for school meal benefits is good for one school year. Do foster children qualify for free meals? Yes, foster children who are the legal responsibility of a foster care agency or court are eligible for free meals regardless of household income. I get WIC. Can my children get free meals? Children in households participating in WIC may be eligible for free or reduced-price meals. Please fill out an application. May I apply if someone in my household is not a U.S. citizen? Yes. You or your children do not have to be U.S. citizens for your children to qualify for free or reduced-price meals. Who should I include as members of my household? Include yourself and all other people living in the household, related or not (such as grandparents, other relatives or friends). Include a household member who is temporarily away, such as a college student. What if my income is not always the same? List the amount that you normally get. If you normally get overtime, include it, but not if you get it only sometimes. How will the information I provide be kept? Information you provide on the form, and your childâ€™s approval for school meal benefits, will be protected as private data. See the back page of the Application for Educational Benefits for more information about how the information is used. Will the information I give be checked? Yes, and we may also ask you to send written proof. What if I disagree with the schoolâ€™s decision about my application? You should talk to school officials. You also may ask for a hearing to review your application.
APPLICATION FOR EDUCATIONAL BENEFITS
Instructions for Completing the Application for Educational Benefits
Complete the Application for Educational Benefits for school year 2013-14 if any of the following apply: - Any household member currently participates in the Minnesota Family Investment Program (MFIP), or the Supplemental Nutrition Assistance Program (SNAP), or the Food Distribution Program on Indian Reservations (FDPIR), or - One or more children in the household are foster children (a welfare agency or court has legal responsibility for the child), or - Total household income (gross earnings, not take-home pay) is within these guidelines: Household Size 1 2 3 4 5 6 7 8 Additional
$ Per Year 21,257 28,694 36,131 43,568 51,005 58,442 65,879 73,316 7,437
Maximum Total Income $ Per $ Twice Per $ Per 2 Month Month Weeks 1,772 886 818 2,392 1,196 1,104 3,011 1,506 1,390 3,631 1,816 1,676 4,251 2,126 1,962 4,871 2,436 2,248 5,490 2,745 2,534 6,110 3,055 2,820 620 310 287
$ Per Week 409 552 695 838 981 1,124 1,267 1,410 144
Children and Foster Status List all children in the household in Section 2.
Indicate that a child is in foster care by checking the box. Include any regular income, for example SSI, to children other than foster children. Do not list occasional earnings like babysitting.
Case Number Complete Section 3 if any household member currently participates in one of the
programs listed in that section. If Section 3 is completed, skip Section 4 (adult names and incomes).
Adults / Household Incomes List all adult household members, whether related or not, in Section 4. Include an adult who is temporarily away, such as a student away at college. Do not complete Section 4 if a case number was provided in Section 3, or if the application is for foster children only. List each adult household member’s gross incomes (not take-home pay) and how often each income is received. For example “W” for Weekly. List gross incomes before deductions. If an income varies, list the amount usually received. For farm/self-employment income only, list net income after subtracting business expenses. Examples of “other income” to include in the last column are farm/self-employment, Veterans benefits and disability benefits. Check the “No Income” column after a person’s name if they have no income. Do not include as income: foster care payments, federal education benefits, MFIP payments, combat pay, or value of assistance received from SNAP, WIC, FDPIR or Military Privatized Housing Initiative.
Signature The form must be signed by an adult household member in section 6. Social Security Number The person signing the application must provide the last four digits of their
Social Security number in section 6 unless: A qualifying case number was provided in Section 3, or All children in the household who need school meal benefits are foster children, or The person signing the application does not have a Social Security number and has indicated this in Section 6.
School Year 2013-14
State and Federally Funded Programs
Office Use Only Total Household Size: _____ Total Income: $ __________ per ________ Case Number – Free Foster – Free Approved (check all that apply): Income – Free Income – Reduced-Price Denied: Incomplete Income Too High Other: ________________ Signature – Determining Official: _______________________ Date: _________ Signature – Confirming Official: _______________________ Date: _________ Change Status To: ________ Reason: _________________ Withdrawn: _____
Office Use Only Date Verification Sent: _______ Response Due: ________ 2nd Notice: ______ Result: No Change Free to Reduced-Price Free to Paid Reduced-Price to Free Reduced-Price to Paid Reason for Change: Income Case number not verified Foster not verified Refused Cooperation Other: Signature – Verifying Official: _________________________ Date: __________
Include all adults living in your household, related or not. Attach additional page if necessary. Last Name First Name if NO Gross Wages/ Pension, SSI, Public Assistance, Unemployment, Any Other Income, income Salaries—all jobs Retirement, Social Child Support, Worker’s Comp, including net Farm/ (before deductions) Security Alimony Strike Benefits Self-Employment $_____ per ____ $_____ per ____ $_____ per ____ $_____ per ____ $_____ per ____ $_____ per ____ $_____ per ____ $_____ per ____ $_____ per ____ $_____ per ____ $_____ per ____ $_____ per ____ $_____ per ____ $_____ per ____ $_____ per ____ Household Incomes: Write in each gross income and how often it is received: weekly (W), bi-weekly (every other week) (BW), twice per month (TM), monthly (M). Do not write in hourly pay. If income fluctuates, write in the amount normally received. Attach additional page if necessary. 5. If your children are approved for school meal benefits, this information may be shared with Minnesota Health Care Programs to identify children who are eligible for Minnesota health insurance programs. Leave the box blank to allow sharing of information. See back page for more information. Do not share information with Minnesota Health Care Programs. 6. I certify (promise) that all information on this application is true and all income is reported. I understand that the school will get federal and state funds based on the information I give. I understand that if I purposely give false information, my children may lose meal benefits and I may be prosecuted. Signature of Adult Household Member (required) _________________________________ Print Name: _______________________________ Date: _________ Social Security number – last 4 digits (required if Section 4 is completed): * * * - * * - __ __ __ __ OR I don’t have a Social Security number Address: ___________________________________ City _______________________ Zip_________ Home Phone: _____________ Work Phone: ___________
- Medical Assistance and WIC do not qualify * Child is the legal responsibility of a welfare agency or court. If all children applied for are foster children, skip Sections 3 and 4. 4. Names of all Adults in Household (all household members not listed in Section 2).
Minnesota Family Investment Program (MFIP) Supplemental Nutrition Assistance Program (SNAP) Food Distribution Program on Indian Reservations
Check here if this is the first application at this school district or nonpublic school for any child listed below. 2. Names of all Children in Household including Foster Children. Attach additional page if necessary. Last Name First Name Date of Birth School if Any Regular Month/Day/Year Foster Income to Child Child* Example: SSI $____ per___ ___/___/___ $____ per___ ___/___/___ $____ per___ ___/___/___ $____ per___ ___/___/___ $____ per___ ___/___/___ 3. Benefits (if applicable) If any household member receives benefits from a program listed below, write in the name of the person & case number, check the appropriate box, & skip Section 4. ___________________ ___________________ Name_________________Case Number
Application for Educational Benefits
Free and Reduced-Price School Meals
Revised May 2013
Edina High School 6754 Valley View Road Revised May 2013 Edina, MN 55439
Children’s Ethnic and Racial Identity (Optional) Please provide the following information, which is used to determine the school’s compliance with civil rights laws. If the information is left blank, a representative of the is school is required to identify the ethnic and racial identity of participants for civil rights reporting. vil rights laws. If the information left blank, a 1. Choose one ethnicity: l rights reporting. Hispanic/Latino Not Hispanic/Latino 2. Choose one or more races (regardless of ethnicity): Asian American Indian or Alaskan Native Black or African American Return your completed application to: Native Hawaiian or other Pacific Islander Food & Nutrition Services White
Nondiscrimination Statement This explains what to do if you believe you have been treated unfairly: In accordance with Federal Law and U.S. Department of Agriculture policy, institution of is Agriculture prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. To file a complaint of aw and U.S.this Department policy, writeofUSDA, Director, Office of Adjudication, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410 or call toll free (866) r disability.discrimination, To file a complaint (Voice). Individuals who are hearing impaired or have speech disabilities may contact USDA through the Federal Relay Service at (800) ington, D.C.632-9992 20250-9410 or call toll free (866) (800) Service 845-6136 (Spanish). USDA is an equal opportunity provider and employer. A through 877-8339; the FederalorRelay at (800)
status forYour school meals (qualified for free or reduced-price meals) may be shared with Minnesota Health Care Programs unless you tell us not lth Care Programs. child’s eligibility to share your information checking the box in Section 5 of the application. You are not required to share information for this purpose and alth Care Programs unless you tell usbynot your decision not affect share information for thiswill purpose andapproval for school meal benefits.
At public school districts, each student's eligibility status is also recorded on a statewide computer system used to report student data to the Department ofthe Education as required by state law. The Minnesota Department of Education uses this information to: (1) administer stem usedMinnesota to report student data to and federal programs, (2) calculate compensatory revenue for public schools, and (3) judge the quality of the state's educational program. ion uses thisstate information to: (1) administer e quality of Children the state's educational program. who are eligible for free and reduced-price school meals may be eligible for Minnesota Health Care Programs. Your child’s eligibility
the lunch and breakfast programs. We may share your eligibility information with education, health, and nutrition programs to help them ls, and for of administration and enforcement evaluate, fund to or help determine h, and nutrition programs them benefits for their programs, auditors for program reviews, and law enforcement officials to help them look into violations of them program ement officials to help lookrules. into
Privacy Act Statement / How Information Is Used The National School Lunch Act requires that the household member signing the application must provide the last four digits of their Social Security number unless the application is for a foster child, or they do not have a Social Security number, or they provide an active assistance vide the last four digits of their Social number from the Minnesota Family Investment Program (MFIP), Supplemental Nutrition Assistance Program (SNAP) or Food Distribution ber, or they provide an active assistance Program on Indian Reservations (FDPIR). Provision of a Social Security number is not mandatory, but if a Social Security number is required Program (SNAP) or Food Distribution forSecurity a complete application and the household does not provide the information, the application cannot be approved. ut if a Social number is required t be approved. We will use your information to determine if your child is eligible for free or reduced-price school meals, and for administration and enforcement
STUDENT INFORMATION RELEASE LIMITATION ON DISTRICT RELEASE OF STUDENT INFORMATION Edina Public Schools recognizes its responsibilities in regard to the collection, maintenance and dissemination of students’ educational records and data. District Policy 515 defines the procedures and practices for protecting the privacy of student information in accordance with state and federal law. Completion of this form is to prohibit the release of student directory information. STUDENT DIRECTORY INFORMATION Directory information regarding a student is public information under state and federal law. Directory information as defined in District Policy 515 includes, but is not limited to, a student’s name, address, telephone number, e-mail address, photograph, date and place of birth, attendance dates, grade level, participation in activities and sports, degrees and awards received, and weight/height of athletic team participants. It also includes the name, address and telephone number of the student’s parent(s). A parent/guardian may refuse to have any or all of the directory information made public by notifying the building principal in writing or via SchoolView (http://asp.tiescloud.net/schoolview/?dst=273) by September 13, 2013. Submission of the bottom of this form to the building principal satisfies this notice requirement. PHOTOGRAPHY As noted above, a student’s photograph/image/recording is also directory information and may be released. A student may be photographed or recorded while at school or participating in school activities and events. Care is taken to ensure that the student and learning/activity/event environment is portrayed appropriately. If you choose not to have your child photographed or recorded by the District, please log in to SchoolView (http://asp.tiescloud.net/schoolview/?dst=273) or, notify the building principal in writing by September 13, 2013. Submission of the bottom of this form to the building principal satisfies this notice requirement. In accordance with District Policy 515, the above-noted designations or refusals will remain valid until the end of the 2013-14 school year. If you have any additional questions please contact your building principal. I, as parent/guardian of the below-named student(s), elect that the district is not able to disclose directory information for the 2013-2014 school year. Please select one of the following choices.
The district may not release any directory information regarding the child(ren) listed below. This election includes the nonrelease of photographs/images/recordings.
The district may not release any photographs/images/recordings of the child(ren), but may release directory information regarding the child.
Child’s Name: _______________________________
Select: oA oB
Child’s Name: _______________________________
Select: oA oB
Child’s Name: _______________________________
Select: oA oB
Child’s Name: _______________________________
Select: oA oB
Parent/Guardian Name (please print): ______________________________________ Parent/Guardian Signature: ______________________________________________
ANNUAL HEALTH & SAFETY NOTIFICATIONS CONCERNING THE USE OF PEST CONTROL MATERIALS:
Our district utilizes a licensed, professional pest control service for the prevention and control of rodents, insects and other pests in and around the district’s buildings. The program consists of: 1. Inspection and monitoring to determine if pests are present and whether any treatment is needed; 2. Recommendations for maintenance and sanitation to eliminate pests without need for pest control materials; 3. Utilization of non-chemical measures such as traps, caulking and screening; and 4. Application of EPA-registered pest control materials when needed. Pests can sting, bite, cause contamination, damage property and spread disease; therefore, we must prevent their presence and control them as necessary. Our district or outside contractors may also apply herbicides on district properties, as deemed necessary. The long-term health effects on children from the application of pest control materials may not be fully understood. All pest control materials are chosen and applied according to labeling directions per Federal law. An estimated schedule of pest control inspections and possible lawn treatments are available for review. Parents of students may submit a request to receive prior notification of any application by calling the school principal or the Buildings and Grounds Department at (952) 848-3999. Material Safety Data Sheets for all pesticides and herbicides utilized are available for review by calling the Buildings and Grounds Department.
ASBESTOS NOTIFICATION FOR STAFF AND BUILDING OCCUPANTS:
The Asbestos Hazard Emergency Response Act (AHERA) requires that each school district notify workers and building occupants annually regarding asbestos-related activities. Until the late 1970s, asbestos was commonly used in commercial and residential building materials, such as floor tile, fireproofing spray and thermal system insulation on pipes, tanks and boilers. In the late 1980s, all school buildings were inspected for asbestos-containing building materials according to AHERA protocol, using accredited inspectors. Based on the results of these inspections, management plans were developed for each school where asbestos was found. These plans are on file at the Edina Community Center and are available for review by contacting the Buildings and Grounds Department (952-848-3999). AHERA also requires that we conduct periodic surveillance inspections every six months to evaluate the condition of asbestoscontaining materials and that we completely re-inspect our buildings every three years. This is done to best ensure all asbestoscontaining materials are maintained in a safe condition. Identified below are asbestos-related activities that were completed over the past year or are planned for the upcoming year. Complete details are available upon written request and copies of inspections are available at each individual school. Activities Scheduled For 2013-2014: • Periodic Surveillance • Abatement activities at Concord associated with the Renovation Project Rest assured that the District is focused on providing a safe and healthy environment for our building occupants and employees, to include ongoing efforts related to the management and control of asbestos-related materials.
INDOOR AIR QUALITY
To help improve our school environment and comply with requirements established by the Minnesota Department of Education (MDE), Edina Public Schools has developed and implemented an Indoor Air Quality Management Plan that addresses indoor air quality issues throughout the District. Walkthroughs and inspections of district buildings are performed annually to detect current problems and help prevent future problems from occurring. Specific district information is available upon request from the Buildings and Grounds Department at (952) 848-3999. General information regarding indoor air quality is available from the Department of Health at www.health.state.mn.us/divs/eh/indoorair/schools/
HEALTH SERVICES INFORMATION IMMUNIZATION REQUIREMENTS FOR KINDERGARTEN, 7TH GRADE, AND NEWLY ENROLLED STUDENTS In order to attend school in Minnesota, state law requires kindergarten, seventh grade, and newly enrolled students to show proof of required immunizations or to file legal exemptions from immunizations with the school. You may review your child’s school immunization record through your School View account (accessible at www.edinaschools. org/parents). A schedule of required immunizations is also located on the Edina Public Schools website under health services. • You will be contacted if immunization information is needed in order for your child to attend school. Updated or new immunization information should be sent to your child’s school health office no later than Friday, August 9, to allow time for processing. • Students entering kindergarten or seventh grade are required to show proof that they have either received two chickenpox (varicella) immunizations or proof from a health care provider that they have had the disease. • A special immunization clinic will be held on Wednesday, August 28 from 4:00-6:00 p.m. at Bloomington Public Health, 1900 W. Old Shakopee Road in Bloomington. Any uninsured or underinsured children are welcome. Immunization clinics are also held on the first and third Tuesdays of every month from 3:00-5:50 p.m. If you have questions about immunization requirements, contact the school health office or Betty Elliott, EPS Health Services Coordinator at 952-848-4890.
Are Your Kids Ready for School? Minnesota’s School Immunization Law Directions:
Find the child’s age/grade level and read across to the right. Look to see whether the child had the number of shots shown by the checkmark(s) under each vaccine. Note: Each row is meant to be read separately, so don’t add up the columns of checkmarks under each vaccine. Example: A preschooler needs 4 DTaP, then to enter kindergarten he or she needs 1 more DTaP, for a total of 5 (not 9).
diphtheria, tetanus, pertussis (whooping cough)
Preschool (age 3-5) Kindergarten
(through Age 6)**
Age 7 through 6th grade
7th through 12th grade * ** *** ****
Three doses recommended
7th grade only***
5 shot not needed if 4th was after age 4
4th polio not needed if 3rd was after age 4
Two doses recommended
Two doses recommended
7th grade only, but recommended for 8-12th grade
measles, Haemophilus mumps, rubella inﬂuenzae type b
Plus one more shot at age 11-12 years****
If the child has already had chickenpox disease, varicella shots are not required but the child’s doctor must sign a form. First graders who are 6 years old and younger must follow the polio and Tdap/DTaP/Td schedules for kindergarten. An alternate 2-shot schedule of hepatitis B may also be used for kids from age 11 through 15 years. If a child received a Td or Tdap at age 7-10 years they do not need another one at age 11-12 years. However, they must receive another shot of Td or Tdap 10 years after their last one.
To go to school in Minnesota, students must show they’ve had these immunizations or ﬁle a legal exemption with the school. Parents may ﬁle a medical exemption signed by a healthcare provider or a conscientious objection signed by a parent/guardian and notarized. Other immunizations recommended for school kids, but not required by the School Immunization Law:
• Inﬂuenza (ﬂu) – each year for children age 6 months through 18 years – especially those with risk factors like asthma and diabetes.
• Hib – an additional two to three doses (depending on the product used) is recommended for all infants in addition to the one dose at or after 12 months of age required for pre-school.
• Pneumococcal vaccine for all infants. • Meningococcal at age 11-12 and a booster at age 16 years, all adolescents age 11-18 years should be vaccinated. • Human papillomavirus (HPV) for adolescents age 11-18 years. • Hepatitis A for children age 1 year and older. Immunization Program P.O. Box 64975 St. Paul, MN 55164-0975 651-201-5503 or 1-800-657-3970 www.health.state.mn.us/immunize
IC# 141-0903 (MDH, 8/2012)
Pupil Immunization Record Student Name _________________________________________________ Birthdate _____________________Student Number __________________
FOR SCHOOL USE ONLY ( ) Complete; booster required in ___________ ( ) In process; 8 mos. expires _____________ ( ) Medical exemption for _________________ ( ) Conscientious objection for _____________ ( ) Parental/guardian consent _____________
Minnesota law requires children enrolled in school to be immunized against certain diseases or file a legal medical or conscientious exemption. Parent: Enter the MONTH, DAY, and YEAR for all vaccines your child received, MED for vaccines that are medically contraindicated, or CO for vaccines that are conscientiously opposed. Sign appropriate signature boxes on reverse. MED: Medical contraindication to immunization, history of disease, or laboratory evidence of immunity. CO: Immunizations are contrary to parent or guardian’s conscientiously held beliefs. School Personnel: Be sure to initial and date any new information that you add to this form after the parent/guardian submits it. Also, record combination vaccines (e.g., DTaP+HepB+IPV, Hib+HepB) in each applicable space.
Type of Vaccine
DO NOT USE () or ()
1st Dose Mo/Day/Yr
2nd Dose Mo/Day/Yr
3rd Dose Mo/Day/Yr
4th Dose Mo/Day/Yr
5th Dose Mo/Day/Yr
Required (The shaded boxes indicate doses that are not routinely given; however, if your child has received them, please write the date in the shaded box.) Diphtheria, Tetanus, and Pertussis (DTap, DTP) Diphtheria and Tetanus (DT) • for 6-year-olds and younger Tetanus and Diphtheria (Tdap, Td) • for 7-year-olds and older Polio (IPV, OPV) Measles, Mumps, and Rubella (MMR) • minimum age: on or after 1st birthday • required for kindergarten and 7th grade Hepatitis B (hep B) • required for kindergarten and 7th grade Varicella (chickenpox) • minimum age: on or after 1st birthday • vaccine or disease history required for kindergarten and 7th grade
Recommended Meningococcal (MCV, MPSV) Human Papillomavirus (HPV) Hepatitis A (hep A)
Additional exemptions: • Children less than 7 years of age: The 5th dose of DTaP/DTP/DT (similarly, the 4th dose of polio vaccine) is not necessary if the 4th DTaP/DTP/DT (3rd dose of polio) was administered after the 4th birthday. • Children 7 years of age and older: A history of 3 doses of DTaP/DTP/DT/Td/Tdap and 3 doses of polio vaccine meets the minimum requirements of the law. • Students in grades 7-12: A Td or Tdap booster at age 11 years or later is not required for students in grades 7-12 whose most recent Td was given after their 7th birthday but before their 11th birthday. Instead, it will be required 10 years after the date of the most recent dose. • Students 11-15 years of age: A 3rd dose of hepatitis B vaccine is not required for students who provide documentation of the alternative 2-dose schedule. • Students 10 years or older: May receive Tdap to fulfill the Td requirement for students in grades 7-12. • Students 18 years of age or older: Do not need polio vaccine. Developed by the Minnesota Department of Health - Immunization Program www.health.state.mn.us/immunize
BOX 1: Certifying Immunization Status BOX 3A: Medical Exemptions
BOX 2: Consent to Share Immunization Information BOX 3B: Conscientious Exemptions
1. Choose one of the following to indicate student’s immunization status and the source of the information above: A. I certify that this student has received all immunizations required by law. ____________________________________________________________________________________________ Signature of parent/guardian or physician/public clinic Date B. I certify that this student has received at least one dose of vaccine for diphtheria, tetanus, and pertussis (if ageappropriate), polio, hepatitis B (K and 7th), varicella (K and 7th), measles, mumps, and rubella and will complete his/ her diphtheria, tetanus, pertussis, hepatitis B, and/or polio vaccine series within the next 8 months. The dates on which the remaining doses are to be given are: ____________________________________________________________________________________________ ____________________________________________________________________________________________ Signature of physician/public clinic Date 2. Parental/Guardian Consent to Share Immunization Information: Your child’s school is asking your permission to share your child’s immunization record with Minnesota’s immunization registry to help us better protect students from disease. You are not required to sign this consent; it is voluntary. In addition, all the information you provide is legally classified as private data and can only be released to those legally authorized to receive it under Minnesota law. I agree to allow school personnel to share my student’s immunization record with Minnesota’s immunization registry: ______________________________________________________________________________________________ Signature of parent or legal guardian Date 3. Exemptions to School Immunization Law A. Medical exemption: No student is required to receive an immunization if they have a medical contraindication, history of disease, or laboratory evidence of immunity. For a student to receive a medical exemption, a physician, nurse practitioner, or physician assistant must sign this statement: I certify the immunization(s) listed below are contraindicated for medical reasons, laboratory evidence of immunity, or that adequate immunity exists due to a history of disease that was laboratory confirmed. (For varicella disease see * below.) Exempted immunization(s): ____________________________________________________________________________________________ ____________________________________________________________________________________________ Signature of physician/nurse practitioner/physician assistant Date *History of varicella disease only. In the case of varicella disease, it was medically diagnosed or adequately described to me by the parent to indicate past varicella infection in ___________. Year ___________________________________________________________________________________________ Signature of physician/nurse practitioner/physician assistant B. Conscientious exemption: No student is required to have an immunization that is contrary to the conscientiously held beliefs of his/her parent or guardian. However, not following vaccine recommendations may endanger the health or life of the student or others they come in contact with. In a disease outbreak schools may exclude children who are not vaccinated in order to protect them and others. To receive an exemption to vaccination, a parent or legal guardian must complete and sign the following statement and have it notarized: I certify by notarization that it is contrary to my conscientiously held beliefs for my child to receive the following vaccine(s): ____________________________________________________________________________________________ ____________________________________________________________________________________________ Signature of parent or legal guardian Date Subscribed and sworn to before me this _______ day of ______________________ 20______ ___________________________________________________________ Signature of notary Developed by the Minnesota Department of Health - Immunization Program www.health.state.mn.us/immunize
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