KAUKAUNA HIGH SCHOOL 1701 County Road CE; Kaukauna, Wisconsin 54130-3916 Office (920) 766-6113 • Fax (920) 766-6157 COREY BAUMGARTNER Principal
JOSHUA CHUDACOFF Associate Principal
CHRIS MCDANIEL Activities Director
MICHELLE VRANEY Associate Principal
July 28, 2017 Dear KHS Families, I sincerely hope that this letter finds you doing quite well and having experienced an enjoyable summer so far! As August is quickly approaching we here at KHS are very excited about the upcoming school year. School will officially start on Tuesday, September 5 and many different people have been passionately preparing to have our school ready to provide our students with the absolute best learning environment and opportunities available. Please know that throughout this school year I will continuously use our high school website and electronic newsletter to keep you informed of any changes and our progress. I humbly request your continued support and involvement in your son’s or daughter’s education throughout the year. I ask for this for when we are all able to truly work together our students will certainly have positive experiences within the classroom and beyond. In addition, please feel free to contact me if you any questions or concerns that you would like to discuss. Each student’s educational journey is unique and presents different challenges, therefore I want to make sure that EACH of our students is properly supported along the way.
Please take the time to read the important information below: 1.
Kaukauna High School students will register for the upcoming school year on Wednesday, August 16, and Thursday, August 17, from 9:00 A.M. until 7:00 P.M. Students from any grade level may come on either day. All students must start the registration process in the commons. You may also pay your fees online. The following forms need to be turned in (Student /Co-curricular Handbook signature page and health form no later than Sept 15, 2017). Photographs for student ID’s, activity passes, and school pictures will be taken on these dates. If you are unable to attend registration you can come to the HS office anytime after the registration dates to pay fees and turn in paperwork. Network Photography will be back at KHS on September 11, 2017 at 7:15 A.M. to take any ID pictures that they have missed. The makeup date for Network photo packages will be October 18, 2017 at 7:15 A.M. in the HS Commons.
2.
The first meeting of the Parent Advisory Committee (PAC) for the 2017-18 school year will be on Monday, September 18, in the High School Library at 6:30 P.M. If you are interested in becoming a member or would like more information about the PAC, contact Sara Hooyman at 920-284-9246, via email at
[email protected] or Corey Baumgartner, Principal, at 766-6113, ext. 6151. Please complete and return the enclosed PAC postcard to the high school office if you are interested in volunteering for the many activities with which the PAC is involved.
3.
Incoming freshmen and any student new to KHS - SAVE THIS DATE! We would like to inform you that on Monday, August 28 from 5:00-5:50P.M., IGNITION Mentors will be serving a complimentary spaghetti dinner. We invite you and your parents to come to the High School Commons to enjoy a complimentary meal with your fellow freshmen and new students. Building tours will also be offered during that time for those who are interested. The “Path to Success” presentation will begin promptly at 6:00 P.M. with break-out sessions to follow. The purpose of orientation is to ensure that incoming students and their families feel comfortable and knowledgeable about the potential experiences of transitioning to high school. Please plan to join us for this evening. We trust this approach to freshman and new students will be meaningful for all.
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4.
The 2017-18 school year for all KHS students will begin on Tuesday, September 5. From 7:50 A.M. to 12:30 P.M. ONLY THE STUDENTS IN GRADE 9 will report to school at that time. Scheduled activities are planned for the entire morning. A lunch will be provided for freshman prior to the afternoon schedule. Freshmen will then be joined by all other high school students for a similar afternoon of classes. Ninth grade students will remain at school and ALL OTHER STUDENTS SHOULD REPORT AT 12:30 P.M. All students should come prepared to attend each of their classes. Buses will run on the normal daily schedule. If an upperclassman needs to ride the bus the first day of school, pickup will be at the regular time in the morning. The student should report to the high school office to be directed to a supervised area during the freshman morning activities. The day will end at 3:11 P.M. with bus pickup at the normal daily scheduled time of 3:15 P.M.
5.
The daily schedule of instructional time will be from 7:50 A.M. – 3:11 P.M. Bus pickup will begin at 3:15 P.M. Passing time between classes is eight minutes and an Advisory Period will be held twice monthly. The Advisory Period will have students grouped by grade. We will have a two-lunch period schedule again this year. The student’s schedule will note whether the student has first or second lunch. We will continue to have closed lunch for all students in Grade 9. Grades 10 through 12 will have open campus if they so desire, though tardy and attendance rules will apply.
6.
Enclosed you will find information in regard to attendance and cell phone usage. Our focus at KHS centers around teaching and learning. We feel it is vitally important that students maintain regular attendance and that distractions are limited within our learning environments. That is why you will find information in regard to attendance procedures and cell phone usage within this packet for your review. Please feel free to call with any questions you may have about either topic.
7.
Students are reminded to enter the building after 7:30 A.M. unless they have an appointment with a faculty member or belong to a club or organization that meets before school. To increase school safety, we are asking all students to enter the building through the doors to the commons only. All other doors will be locked. Please plan accordingly. REGISTRATION INFORMATION
8.
Parents and students are expected to review ONLINE the Student-Parent Handbook, which includes the Co-Curricular Policy, the WIAA High School Athletic Eligibility Information Bulletin, and the Kaukauna Area School District Policy 443.8-Suspicionless Random Drug Testing, then sign and return the Student-Parent Handbook/Co-Curricular Policy/WIAA High School Athletic Eligibility Information Bulletin/Kaukauna Area School District Policy 443.8-Suspicionless Random Drug Testing Signature Sheet to the high school office at registration, before the first sports practice of any sport starting before registration, or no later than September 15 indicating that you have read and understand the information. ALL parents/guardians and students of Kaukauna High School MUST sign and return the Student-Parent Handbook/ Co-Curricular Policy/WIAA High School Athletic Eligibility Information Bulletin/Kaukauna Area School District Policy 443.8- Suspicionless Random Drug Testing Signature Sheet.
9.
Student fees of $30.00, ID fee of $3.00, and a planner fee of $5.00 are required to be paid at registration. In addition, class fees for all trimesters are to be paid at the time of registration, along with any overdue fees or fines. Class fees that are due for this year will be available to view on the Parent Portal prior to registration. A Registration Checklist with course fees is posted online for your convenience in determining class fees. If you are unable to attend registration, you may register in the high school office after August 17.
10.
Uniform guidelines have been established by the District for school and class fee charges for those that qualify for free and reduced lunch. A new application for Free/Reduced Lunch must be completed each year. The form, which is enclosed in this packet, may be returned to the high school office. Students that qualify for free lunch prices do not
KAUKAUNA STRONG
have to pay any amount of the school or class fees and students that qualify for reduced lunch prices are responsible for 50% of school and class fees. Also, all students will still be responsible for a fee for a project that is above the requirements of the class and for such things as lost or damage to textbooks, lost or damaged Chromebooks, lost supplies, etc., regardless of their lunch status. 11.
Student parking on school grounds is a privilege. All students are expected to familiarize themselves and comply with established rules and expectations, including the Kaukauna Area School District Policy 443.8-Suspicionless Random Drug Testing. By purchasing a parking permit, the student and parent agree to participate in suspicionless random drug testing and give permission for testing and the release to the district concerning the results of said testing in the event they are randomly selected and understand this agreement is binding through graduation from high school. The fee for a parking permit is $30.00 for the school year or $10.00 per trimester. Students must have a parking permit in order to park in the main student located on the north of the High School. Current permits must be on vehicles by September 15 to avoid consequences.
12.
The 2017-18 yearbook will be available for ordering online through a link on KHS website. The price of the book is $50.00 if ordered between (July 16, 2017–September 29, 2017), $54.00 (September 30, 2017-March 23, 2018) and $60.00 (March 24, 2018-May 25, 2018).
13.
All students must have their pictures for ID cards taken at this time. ID cards will be issued immediately at registration. For those students who do not have their ID pictures taken on registration days, pictures will be taken on September 11, 2017. Please remember to dress appropriately and that no hats are allowed on photos. A student must be in possession of their ID to check out materials from the Information Center, and for Grade 10, 11, and 12 students, to leave school grounds for lunch. Replacement ID’s are issued through the office at a cost of $10.00.
14.
Activity passes will be sold at registration for $25.00 per student. Activity passes will be printed directly on school issued ID’s. Please be sure to purchase your activity pass prior to having your photo taken. Passes for adults will also be available at registration for $50.00. Passes will allow entrance to all home athletic events other than special tournaments we host and WIAA Regional or Sectional contests. An “on-the-road” pass is $35.00 and is good for admission to other FVA schools’ events. Fees for home events without a pass will be $5.00 for adults and $2.00 for students. Senior citizens (age 60 and over) will be allowed in free to regular season events.
15.
Athletic/Activity fees will also be collected from those who are certain they will be participating in a fall sport or school activity. Again this year, there will be a fee to join all WIAA sponsored athletic programs. The following teams will be charged for participation: Boys and Girls Cross Country, Football, Boys and Girls Volleyball, Boys and Girls Tennis, Boys and Girls Golf, Boys and Girls Soccer, Boys and Girls Basketball, Wrestling, Gymnastics, Baseball, Softball and Boys and Girls Track. The following activities will be charged for participation: Forensics and Math Team. The fees will be $40.00 per sport/activity, capped at $80.00 per student and $200.00 per family. Athletic fees will be collected by the coaches or can also be paid at registration. There will be no refunds for those who quit a team or are removed for disciplinary reasons during the season.
16.
Physical forms, Alternate Year cards, and the REQUIRED Concussion Parent-Athlete Agreement form can be picked up in the KHS office. The forms are also available on website. The completed forms need to be turned in to the school before students can participate in practice or try-outs and are available on the High School website.
17.
Payments: ● Registration fees may be paid with check or cash, or online with a credit/debit card (school fees, planner fee, ID photo fee, class fees, past fees, and/or fines). ● Parking permits may be paid by check or cash only. ● Activity passes and activity fees require a SEPARATE check or cash only. ● Student picture orders require a SEPARATE check or cash at registration or online with a credit/debit card. For online payment go to Kaukauna High School Picture Prepay Online 2017 ● Chartwells Dining Services lunch account payments will require a SEPARATE check, cash, or online credit/debit card payment.
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18.
KHS is proud to announce that this school year students grades 9, 10 and 11 with have the opportunity to participate in our 1:1 Initiative where they will be issued a Google Chromebook. We are very excited about the expansion of this technology initiative and the positive impact that it will undoubtedly have on student learning. Included in this packet you will find a KASD Chromebook Loan Agreement form that also needs to be completed for registration in addition to a student guide for proper use and handling of the device.
19.
Enclosed are the following forms: Student-Parent Handbook/Co-Curricular Policy/WIAA High School Athletic Eligibility Information Bulletin/Kaukauna Area School District Policy 443.8- Suspicionless Random Drug Testing signature sheet, health information form, Parent Advisory Committee (PAC) handout, PAC Volunteer Card, Parents’ Guide to School lunch 2017-18, directions on how to apply for free/reduced lunch online, wellness screening consent form (grade 9 only), 2017-18 calendar, student parking permit application for grade 11 and 12 students, Registration checklist, school supply list, senior photo guidelines and a picture order form for students in grades 9, 10, and 11. The Health Information form and student/co co-curricular handbook signature page must be returned at the time of registration or no later than September 15.
20.
Registration forms are also posted online at http://www.kaukauna.k12.wi.us/family/forms.cfm or by going to district home page, family resources, KASD Forms. ● Handbook/Code signature page ● Registration checklist ● Supply list ● Directions on how to apply for free and reduced lunch online ● Parents’ Guide to School Lunch ● Parking permit ● Health informational form ● Chromebook guidelines and loan agreement ● Network Photography packages ● Wellness consent form (9th grade only) ● 2017-18 parent calendar ● Senior Photo Guidelines
21.
Also enclosed is a Census Verification Form. Listed on the form is the information we currently have on record in Infinite Campus. Please make any changes/additions, sign, and return at registration. You may also update your information using the Parent Portal.
22.
In a continued effort to reduce costs of postage and mailing supplies, Kaukauna High School will once again not be mailing newsletters, week 6 progress reports, or report cards this year. This information is always available on the parent portal. If you have not used the parent portal and need a user ID and password, please send an email to
[email protected].
23.
If you do not have internet access, you may call 766-6113, ext. 5471, and request that your name be put on the mailing list.
In closing, please know that I am extremely excited to have the opportunity to work with each and every student as we strive to support them on their path of success here at KHS and beyond. I am wholeheartedly devoted to this school community and feel immensely honored to serve our stakeholders. We are looking forward to a great upcoming school year! Sincerely,
Corey Baumgartner Principal
KAUKAUNA STRONG
Registration Check List 2017-2018 Please review the following list prior to registering for the 2017-18 school year at Kaukauna High School. Remember, the Parent-Student Handbook is posted at the KHS website. Parents and students are expected to review the handbook and return a signed Student-Parent Handbook/Co-Curricular Policy/WIAA High School Athletic Eligibility Information Bulletin/ Kaukauna Area School District Policy 443.8 – Suspicionless Random Drug Testing Signature Sheet to the high school office at registration, before the first sports practice of any sport starting before registration, or no later than September 8. The form is required of all students and will stay on file in the office indicating that you and your student have read and understand the information. If you do not have access to the internet, please contact the office, 766-6113 extension 5471, to be put on the mailing list.
ITEMS REQUIRED AT REGISTRATION
$38.00: $30.00 - school fees $5.00 - planner/handbook $3.00 - student I.D. fee Census Verification Report- Please make any changes/additions, sign, and return at registration. You may also update your information using the Parent Portal. Student-Parent Handbook/Co-Curricular Policy/WIAA High School Athletic Eligibility Information Bulletin/Kaukauna Area School District Policy 443.8 – Suspicionless Random Drug Testing Signature Sheet Health Information form
Chrome Book Agreement form (9th and 11th grade only) Wellness screening consent form (9th Grade optional)
MISCELLANEOUS ITEMS
Student Parking Permit Application - $30.00 fee ($10.00 per trimester), students must show a valid Wisconsin Driver’s License Free/Reduced Lunch Form (Must be filled out each year) Network Photo School Pictures (Optional, see enclosure) Parent Advisory Committee (PAC) Information/postcard (orange) 2017-18 Parent Calendar School supply list Registration check list-Class fees for all trimesters
Course Fees Additional project fees/field trip costs in any of the classes will be determined by the teacher/student contract.
5610 Intro to Anatomy/Physiology .............................. $15.00 8160 8161 8172 8175 8185
Nutritional Science ............................................ $15.00 Culinary I........................................................... $15.00 Culinary II.......................................................... $15.00 Culinary III......................................................... $30.00 Culinary III......................................................... $30.00
4984 8610 8611 8612 8660 8661 8662 8663 8664 8676 8710 8730 8732 8740 8760 8761 8762 8763 8764 8765
Robotic Systems Lab ........................................ $25.00 Wood Technology ............................................. $10.00 Modern Construction ......................................... $12.00 Applied Woodworking ....................................... $22.00 Metal Tech I ...................................................... $15.00 Metal Tech II ..................................................... $15.00 Consumer Auto Maintenance ............................ $17.00 Automotive ABC’s ............................................. $17.00 Applied Auto Tech ............................................. $27.00 Engineering I – BL ............................................ $20.00 Production Graphics.......................................... $10.00 DC Electronics ................................................. $25.00 Architectural Design .......................................... $10.00 Electronics II………………………………………..$25.00 Screen Printing ................................................. $10.00 Solidworks Engineering I…………………………$10.00 Solidworks Engineering II………………………...$10.00 Solidworks Engineering III ................................. $10.00 Solidworks Engineering IV ................................ $10.00 Offset Press ...................................................... $10.00
1610 CAPP College English I………………………… $300.00 1620 CAPP American Lit……………………………... $300.00 7560 CAPP Personal Finance……………………….. $300.00 9562 CAPP Music Theory……………………………. $300.00 6930/6940 CAPP Spanish V………………………… $500.00 7430 CAPP Entrepreneurship…………………………$300.00 8679 CAPP Engineering I………………………......... $200.00 3270 CAPP Personal Health and Wellness………… $300.00
9161 Drawing I ........................................................... $10.00 9162 Drawing II .......................................................... $10.00 9163 Drawing III ......................................................... $10.00 9164 Drawing IV......................................................... $10.00 9165 Drawing V.......................................................... $10.00 9261 Traditional Photo I ............................................. $70.00 9262 Traditional Photo II ............................................ $70.00 9263 Traditional Photo III ........................................... $70.00 9264 Traditional Photo IV ........................................... $70.00 9266 Painting I ........................................................... $10.00 9267 Painting II .......................................................... $10.00 9271 Painting III ......................................................... $10.00 9268 Sculpture I ......................................................... $10.00 9269 Sculpture II ........................................................ $10.00 9270 Digital Imaging................................................... $10.00 9361 Clay I ................................................................. $22.00 9362 Clay II ................................................................ $22.00 9363 Clay III ............................................................... $22.00 9364 Clay IV .............................................................. $22.00 9369 Clay V ............................................................... $22.00 9380 Clay VI .............................................................. $10.00 9365 Metals I.............................................................. $10.00 9366 Metals II ............................................................. $10.00
Music Department Fees: 9711 9722 9730 9810 9811 9832 9723 9724 9725 9726
Concert Band .................................... $15.00 Wind Ensemble ................................. $15.00 Orchestra .......................................... $15.00 Concert Choir .................................... $15.00 Treble Choir ...................................... $15.00 Ambassador Choir ............................ $15.00 Con. Band & Con Choir……………….$15.00 Ambass. Choir & Orchestra…………..$15.00 Wind Ens. & Ambass. Choir……….....$15.00 Wind Ens. & Orchestra………………..$15.00
Charges for 9711, 9722, 9730, 9810, 9811, and 9832 will be assessed only once per student, not each course.
KAUKAUNA HIGH SCHOOL SCHOOL SUPPLIES FOR 2017-2018 SCHOOL YEAR All students should have a supply of loose-leaf paper, pens, pencils, eraser, spiral notebooks, and pocket folders. Additional items may be requested throughout the school year Art
Science
Drawing I, II, III, & IV: 9x12" or smaller sketchbook, pink pearl eraser, #2 pencils (not mechanical) Digital Photography I and II: 8 or 16 GB SDHC card (SanDisk or Lexmark recommended) Traditional Photography: 1” binder, rubber gloves (optional) Foundations of Art: 9x12” or smaller sketchbook, Pilot G-2 gel pen (black)
Biology, Life Science & Anatomy and Physiology: 2” three ring binder, binder dividers, loose leaf paper and colored pencils or pens, whiteboard marker. Chemistry, Accelerated Chemistry & Advanced Chemistry: Scientific calculator, whiteboard marker, and a notebook. Physics, AP Physics: Notebook, dry-erase markers, and a scientific calculator (AP Physics requires a graphics calculator). Applied Science I & Ii:: Pocket folder, loose leaf paper, notebook, colored pencils or pens, and a calculator. Forensics Science: Notebook or composition book, folder, and a scientific calculator. PLTW Biomedical Sciences: Notebook or composition book, 3 ring binder, calculator AP Biology: notebook or loose leaf for note taking, a lab notebook with carbon pages, and a non-scientific 4-function calculator with square root.
Business and Information Technology Education Binder, notebook, calculator, pen/pencil, ruler, folder, 2 different colored highlighters, Clorox or sanitizing wipes Desktop Publishing: Flash Drive recommended
ESL ESL Resource: basic calculator
English English 9: folder, loose-leaf paper or notebook, pens/pencils, 3 different colors of highlighters, 1 pack post-it notes English 10: folder, loose-leaf paper or notebook, pens/pencils, 3 different colors of highlighters, 1 pack post-it notes English 11: folder, loose-leaf paper or notebook, pens/pencils, 3 different colors of highlighters, 1 pack post-it notes English 12: folder, loose-leaf paper or notebook, pens/pencils, 3 different colors of highlighters, 1 pack post-it notes
Family & Consumer Education Scissors. Glue stick. Markers, crayons or colored pencils, folder or binder, paper – loose leaf or spiral, flash drive
Health Class Three ring binder (any size), loose-leaf paper, tabs for the binder, red pen, highlighter, colored pencils/markers
Mathematics All math classes require paper, pencils and eraser, dry erase markers, straight edge, and a calculator. Advanced Algebra/Trigonometry, Pre-Calculus, Statistics and AP Statistics require the TI-83 or TI-84 Graphing Calculator; Calculus requires the TI-89 Graphing Calculator; All other math classes require the TI-30XIIS calculator. The following teachers have specific items that should be purchased: Mrs. Fuller: 1” or 1.5” three ring binder, dividers, and loose leaf paper Mrs. Nettekoven: three ring binder, divider, loose leaf paper, highlighter Mrs. Stradel: three ring binder, dividers, and loose leaf paper
Music Choir – 1” three ring binder – black
Physical Education All Classes: Change of clothes suitable for safe participation in physical activity: t-shirt or sweatshirt, shorts or sweatpants (no cut-off’s; no buckles, snaps, zippers that could pose a safety concern) shoes appropriate for safe participation in physical activity (rubber non-marking sole; no open back or open toe shoes), pencil or pen (no red ink), notebook or folder Individual & Dual Sports: Golf field trip fee - $8.00
Social Studies Economics: Calculator Ms. Engman, Mr. Flores, and Ms. VanArk: three ring binder, loose leaf paper All Courses: Colored pencils, markers, flash drive
Special Education Math 0412 & 0422: three ring binder, dividers, basic calculator English 0411 & 0421: three ring binder, dividers, flash drive Skills Lab 0430 & 0440: Pocket folder Math Transitions 0119 & 0129: basic or scientific calculator (fraction capable) Skills Lab Math: graph paper, basic or scientific calculator (fraction capable) EFFORTJob Exploration: 2 highlighters (different colors), Job Skills: Social Security card and birth certificate, picture ID, available when hired Independent Work: Flash drive/USB memory stick to save documents
Technology and Engineering Auto Tech: safety glasses DC Electronics:: Scientific Calculator basic Metals classes: safety glasses, black Sharpie Production Graphics: 1" three ring binder, binder dividers, calculator Woods classes: 16’ tape measure, safety glasses, earplugs, calculator, work coat
World Languages French I, II, III, IV & V: see general supply list at the top of the page French III & IV & VI: French/English dictionary Spanish I, II, III, IV & V: see general supply list at the top of the page Spanish III, IV & V: Spanish/English dictionary
2017-2018
STUDENT-PARENT HANDBOOK
CO-CURRICULAR POLICY
WIAA HIGH SCHOOL ATHLETIC ELIGIBILITY INFORMATION BULLETIN
KAUKAUNA AREA SCHOOL DISTRICT POLICY 443.8 – SUSPICIONLESS RANDOM DRUG TESTING SIGNATURE SHEET
(SIGNATURE REQUIRED BY ALL STUDENTS AND PARENTS/GUARDIANS) Dear Parents/Guardian and Student: The Kaukauna High School Student-Parent Handbook, including the Co-Curricular Policy, WIAA High School Athletic Eligibility Information Bulletin, and the Kaukauna Area School District Policy 443.8 - Suspicionless Random Drug Testing is available for you to review online at http://www.kaukauna.k12.wi.us/schools/high/ under Quick Links. This handbook has been prepared to be a source of information for students and parents. Students are responsible for the contents. Parent and student signatures are required to show that a copy of this document has been reviewed electronically or as a paper document. Please sign the signature page and return it to the school. This book reflects the policies of the Board of Education as well as regulations set by the State of Wisconsin and will be in effect during the 2017-2018 school year unless preempted by law. The Student - Parent Handbook is not a contract between the school and parents or students. It can be amended at any time at the discretion of the school district. If the district makes changes to the handbook during a school year, the administration will communicate those changes in ways that are designed to inform parents and students of the new or revised information. Please understand that this Handbook is intended to serve as a reference and guide for your use. However, during the course of the school year, it is impractical to address every circumstance or situation that could possibly occur. Therefore, the principal and/or district administrator has the authority to make decisions in the best interest of the students, faculty and the school. Please refer to the Board Policies in the handbook. A copy of the district’s board policies is available online at www.kaukauna.k12.wi.us. Please read the entire Student-Parent Handbook with your son or daughter and return this form signed by both parent/guardian and student indicating that you have read and understand the handbook, including the Co-Curricular Policy, WIAA High School Athletic Eligibility Information Bulletin, and the Kaukauna Area School District Policy 443.8 Suspicionless Random Drug Testing and agree to follow the requirements stated therein. Please be aware that your signature provides your written consent to the Kaukauna Area School District Policy 443.8 - Suspicionless Random Drug Testing. The student will remain in the pool for suspicionless random drug testing through graduation from high school. This signed form must be completed and submitted to the high school office at registration, to the high school office.
Thank you. Corey Baumgartner Principal
STUDENT - PARENT HANDBOOK I have read and understand the Student-Parent Handbook and agree to abide by all of the information contained therein. I further certify that if I have not understood any information contained in this document, I have sought and received an explanation of the information prior to signing this statement. Student Name (Please Print)
Grade
Student Signature
Date
Parent/Guardian Name (Please Print) Parent/Guardian Signature
Date
CO-CURRICULAR POLICY and WIAA HIGH SCHOOL ATHLETIC ELIGIBILITY INFORMATION BULLETIN I have read and understand the Co-Curricular Policy and agree to abide by all of the information contained therein. I have also read and understand the WIAA High School Athletic Eligibility Information Bulletin. I further certify that if I have not understood any information contained in this document, I have sought and received an explanation of the information prior to signing this statement. As a student, I understand that my participation in co-curricular activities is a privilege and, therefore, agree to be bound by the Kaukauna High School Co-Curricular Policy. I agree to participate in suspicionless random drug testing and give permission for testing and the release to the district concerning the results of said testing in the event I am randomly selected. I understand this agreement is binding through my graduation from high school. Student Name (Please Print)
Grade
Student Signature
Date
I have read and understand the Co-Curricular Policy and agree to abide by all of the information contained therein. I have also read and understand the WIAA High School Athletic Eligibility Information Bulletin. I further certify that if I have not understood any information contained in this document, I have sought and received an explanation of the information prior to signing this statement. As a parent, I understand that my son/daughter’s participation in co-curricular activities is a privilege and, therefore, agree that they are to be bound by the Kaukauna High School Co-Curricular Policy. I give my permission for my son/daughter to participate in suspicionless random drug testing and give permission for testing and the release to the district concerning the results of said testing in the event he/she is randomly selected. I understand this agreement is binding through my son/daughter’s graduation from high school.
Parent/Guardian Name (Please Print) Parent/Guardian Signature
Date
Kaukauna Area School District Chromebook Loan Agreement
Your child is being assigned a Chromebook computer for his/her use during the school year. Each student is responsible for the care and proper use of the device assigned to him/her. The same device will be assigned to the student for multiple years. This equipment is, and at all times remains, the property of Kaukauna Area School District and is lent to the student for educational purposes only for the academic school year. The Chromebook may not be defaced or destroyed in any way. The device must be used in accordance with the District’s Acceptable Use Policy as well as, local, state, and federal statutes. Inappropriate use of the machine may result in the student losing his/her right to use this Chromebook. The equipment must be returned to the school if the student withdraws from Kaukauna Area School District or when requested by Kaukauna Area School District. Identification and inventory tags have been placed on the Chromebook. These tags are not to be removed or modified. If they become damaged or missing, contact tech support for replacements. Additional stickers, labels, tags, or markings are not to be added to the Chromebook. The District will obtain reimbursement from, or on behalf of, student(s) for any damage to, loss of, or failure to return school property. I understand that I am responsible for 100% of any damage or loss to the loaned computer equipment. The replacement cost for the Chromebook is $350.00, Cord is $80.00 and Case is $25.00. PLEASE CHECK One of the boxes below and sign the agreement ⬜ YES. I would like to participate in the 1to1 program. I agree to the terms of participation including my responsibility for damage or loss not covered by the program. ⚪ (High school only). If permitted, my student may keep his/her device over the summer (Grades 911) ⚪ My student will turn in his/her device each year on the last day of his/her school year ⬜ Yes, my student will take a 1to1 device BUT MY STUDENT WILL LEAVE THE DEVICE AT SCHOOL each night. I understand that I am responsible for 100% of any theft or loss of the device. ⬜ NO. I decline to participate in the 1to1 program. I will provide my student with a technology device capable of running Google Docs and the Chrome browser. By signing I agree to the terms of this agreement Student Name (print):___________________________________________Class of: ____________(ex 2022) Student Signature: ______________________________________________ Date: _________________ Parent Signature: _______________________________________________ Date: _________________
Student Guide to Chromebooks Students are responsible for the general care of the Chromebook they have been issued by the school. Chromebooks that are broken or fail to work properly must be taken to the LMC as soon as possible so that they can be taken care of properly. Districtowned Chromebooks should never be taken to an outside computer service for any type of repairs or maintenance. Students should never leave their Chromebooks unattended at school except when locked in their locker. General Precautions ● No food or drink should be next to Chromebooks. ● Cords, cables, and removable storage devices must be inserted carefully into Chromebooks. ● Chromebooks should not be used or stored near pets. ● Chromebooks should not be used with the power cord plugged in when the cord may be a tripping hazard. ● Chromebooks must remain free of any writing, drawing, stickers, and labels. ● Heavy objects should never be placed on top of Chromebooks. Cases ● Each student will be issued a protective case for his/her Chromebook. The Chromebook should never be taken out of this case. ● Although the cases are padded to help protect the Chromebooks, they are not guaranteed to prevent damage. It remains the student’s responsibility to care for and protect his/her device. Carrying Chromebooks ● Always transport Chromebooks with care and in the school issued protective case. Failure to do so may result in disciplinary action. ● Never lift Chromebooks by the screen. ● Never carry Chromebooks with the screen open. Screen Care ● The Chromebook screen can be damaged if subjected to heavy objects, rough treatment, some cleaning solvents, and other liquids. The screens are particularly sensitive to damage from excessive pressure. ● Do not put pressure on the top of a Chromebook when it is closed. ● Do not store a Chromebook with the screen open. ● Make sure there is nothing on the keyboard before closing the lid (e.g. pens, pencils, or disks). ● Only clean the screen with a soft, dry microfiber cloth or antistatic cloth. Asset Tags ● All Chromebooks will be labeled with a District asset tag. ● Asset tags may not be modified or tampered with in any way. ● Students may be charged up to the full replacement cost of a Chromebook for tampering with a District asset tag or turning in a Chromebook without a District asset tag. Using Your Chromebook At School ● Students are expected to bring their District issued Chromebook fully charged to school every day and bring their Chromebooks to all classes unless specifically advised not to do so by their teacher. If a student does not bring his/her Chromebook to school ● A student may stop in the LMC and check out a loaner for the day. ● A student borrowing a Chromebook must sign a loaner agreement and will be responsible for any damage to or loss of the issued device. ● Excessive Checkouts may cause the student to lose their ability to take the device home. ● The students that obtain a loaner will be responsible for returning the borrowed device to the LMC before 3:20 p.m.
● If a loaner is not turned in by 3:20 p.m., the LMC will submit a report to the office. Chromebooks being repaired ● Loaner Chromebooks may be issued to students when they leave their schoolissued Chromebook for repair in the LMC. ● A student borrowing a Chromebook must sign a loaner agreement and will be responsible for any damage to or loss of the loaned device. ● While the Chromebook is being repaired, the loaner Chromebook may be taken home at the end of the school day (students issued a Chromebook). ● Students will receive an email when their devices are repaired and available to be picked up. Charging Chromebooks (students issued a Chromebook) ● Chromebooks must be brought to school each day with a full charge. ● Students should charge their Chromebooks at home every evening. ● There will be a limited number of unsupervised charging stations in the library available to students on a firstcomefirstserved basis. Backgrounds and Themes ● Inappropriate media may not be used as Chromebook backgrounds or themes. The presence of such media will result in disciplinary action. Sound ● Sound must be muted at all times unless permission is obtained from a teacher. ● Headphones may be used at the discretion of the teachers. ● Students should have their own personal set of headphones for sanitary reasons. Printing ● Students will be encouraged to digitally publish and share their work with their teachers and peers when appropriate. Printing stations will be available in the library and other various locations. Because all student work should be stored in an Internet/cloud application, students will not print directly from their Chromebooks at school. Each print station will consist of a desktop computer and networked printer. Students may log into a print station to print their work. Students may set up their home printers with the Google Cloud Print solution to print from their Chromebooks at home. Information about Google Cloud Print can be obtained here: http://www.google.com/cloudprint/learn/. Logging into a Chromebook ● Students will log into their Chromebooks using their school issued Google Apps for Education account. ● Students should never share their account passwords with others, unless requested by an administrator. Managing and Saving Your Digital Work With a Chromebook ● The majority of student work will be stored in Internet/cloud based applications and can be accessed from any computer with an Internet connection and most mobile Internet devices. ● Some files may be stored on the Chromebook’s hard drive. ● Students should always remember to save frequently when working on digital media. ● The district will not be responsible for the loss of any student work. ● Students are encouraged to maintain backups of their important work on a portable storage device or by having multiple copies stored in different Internet storage solutions. Using Your Chromebook Outside of School (students issued a Chromebook) ● Students are encouraged to use their Chromebooks at home and other locations outside of school. A WiFi Internet connection will be required for the majority of Chromebook use, however, some applications can be used while not connected to the Internet. Students are bound by the Kaukauna Area School District Acceptable Use of Technology Policy, Administrative Procedures, and all other guidelines in this document wherever they use their Chromebooks. Operating System and Security
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Students may not use or install any operating system on their Chromebook other than the current version of ChromeOS that is supported and managed by the district. ● The Chromebook operating system, ChromeOS, updates itself automatically. Students do not need to manually update their Chromebooks. ● There is no need for additional virus protection. Content Filter ● The district utilizes an Internet content filter that is in compliance with the federally mandated Children’s Internet Protection Act (CIPA). All Chromebooks while in the District will have all Internet activity protected and monitored by the district. If a website is blocked during school hours, then it will be blocked out of school. If an educationally valuable site is blocked, students should contact their teachers or the media center staff to request the site be unblocked. If the device leaves the District network there will only be minimal filtering provided but all activity will be recorded by the District. No Expectation of Privacy ● Students have no expectation of confidentiality or privacy with respect to any usage of a Chromebook, regardless of whether that use is for districtrelated or personal purposes, other than as specifically provided by law. The District may, without prior notice or consent, log, supervise, access, view, monitor, and record use of student Chromebooks at any time for any reason related to the operation of the District. By using a Chromebook, students agree to such access, monitoring, and recording of their use. Monitoring Software ● Teachers, school administrators, and the technology department staff may use monitoring software that allows them to view the screens and activity on student Chromebooks. Appropriate Uses and Digital Citizenship ● Schoolissued Chromebooks should be used for educational purposes and students are to adhere to the Acceptable Use of Technology Policy and all of its corresponding administrative procedures at all times. ● While working in a digital and collaborative environment, students should always conduct themselves as good digital citizens by adhering to the following: ● Respect Yourself. I will show respect for myself through my actions. I will select online names that are appropriate. I will use caution with the information, images, and other media that I post online. I will carefully consider what personal information about my life, experiences, or relationships I post. I will use appropriate, respectful language I will act with integrity. ● Protect Yourself. I will ensure that the information, images, and materials I post online will not put me at risk. I will not publish my personal details, contact details, or a schedule of my activities. I will report any attacks or inappropriate behavior directed at me while online. I will protect passwords, accounts, and resources. ● Respect Others. I will show respect to others. I will not use electronic mediums to antagonize, bully, harass, or stalk people. I will show respect for other people in my choice of websites: I will not visit sites that are degrading to others, pornographic, racist, or inappropriate. I will not enter other people's private spaces or areas. ● Protect Others. I will protect others by reporting abuse and not forwarding inappropriate materials or communications. I will avoid unacceptable materials and conversations. ● Respect Intellectual property. I will request permission to use copyrighted or otherwise protected materials. I will suitably cite all use of websites, books, media, etc. I will acknowledge all primary sources. I will validate information. I will use and abide by the fair use rules. Chrome Web Apps and Extensions ● Students are allowed to install appropriate Chrome web apps and extensions from the Chrome Web Store.
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Students are responsible for the web apps and extensions they install on their Chromebooks. Inappropriate material will result in disciplinary action. Some web apps will be available to use when the Chromebook is not connected to the Internet. Students should not knowingly install Apps or Extensions that interfere with the operation of the Chromebook, monitoring software, or the district network. Chromebook Identification ● The district will maintain a log of all Chromebooks that includes the Chromebook serial number, asset tag code, and name and ID number of the student assigned to the device. ● Each student will be assigned the same Chromebook for the duration of his/her time in the Kaukauna Area School District. Take good care of it! Collection/Inspection ● Chromebooks will be inspected and/or collected at the discretion of the district ● Chromebooks will be collected for inspection/cleaning at the end of their 7th and 8th grade years. Repairing/Replacing Your Chromebook/Power Cords/Case ● All Chromebooks in need of repair must be brought to the LMC as soon as possible. ● Problems with connections or equipment failure will be repaired at no cost ● Any damaged caused by improper use or care will be billed to the student ○ First Issue The District will assume the cost of the repair ○ Second issue The student/parent will pay $59 fine (the cost of the insurance) ○ Third and subsequent issue The student/parent will pay a fine equal to the repair/replacement ■ Chromebook = $350.00 ■ Cords = $80.00 ■ Case = $25.00
2017-2018 STUDENT PARKING PERMIT APPLICATION Kaukauna High School authorizes students to drive motor vehicles to school and park on school grounds with the expectation that students will comply with established regulations as developed and administered by the school administration. Students shall use only the designated parking facilities. This includes the lot in the main parking area. Any student who violates established motor vehicle regulations shall be disciplined accordingly. Students will pay $30.00 per year and present a valid Wisconsin Driver’s License to receive a permit. The prorated fee for a permit is $10.00 per trimester. In being granted a permit the holder agrees to abide by the following regulations and assumes responsibility for any driver or occupant of the registered vehicle(s). Further, the holder releases the Board of Education from any liability for damage to the vehicle(s) due to accident, vandalism, theft, or the condition of the parking lot. Parking Permit Information: Students and Staff each have different designated parking areas. During school hours parking will be allowed by permit only. A parking permit must be hung properly on the rear view mirror when the vehicle is parked. Vehicles not displaying a parking permit will be issued a $10.00 municipal parking ticket. The number of parking permits issued may be limited. Seniors and juniors will receive preference. Permits are transferable to any vehicle in the student's family which the student chooses to use. Permits lost, stolen, or having the numbers defaced will be replaced at full price. Permits permanently taken away from a student for rule violations will not be reimbursed. Permits may be taken away from students found to be habitually truant as defined by state statute in the attendance section of the student handbook. Parking Lot Rules: All posted signs must be obeyed. Vehicles must form a single line in each row and not cut across parking stall rows. Vehicles must not stop or stand in a parking row end cap. Students must not drive or merge aggressively. This could result in loss of permit without warning. There will be no horn blowing, revving of engines, squealing of tires, or otherwise disorderly conduct with a vehicle. This could result in loss of permit without a warning. No loitering in and around vehicles parked on school property. All students are expected to lock their vehicles and proceed directly to and from their vehicles. Permit holders are responsible for any activities that occur in their vehicles and may be subject to disciplinary action. No throwing refuse out of vehicles on to the parking lot or adjacent property. This could result in loss of permit without a warning. No violations of school rules while in or near vehicles in the school parking lot. Any other actions by the permit holder while in and around vehicles that are determined by the administration to be detrimental to the health, safety, and welfare of students, staff and visitors to the high school will not be allowed. This could result in loss of permit without a warning. Permits may be taken away or not issued to students that have outstanding restricted lunches to serve from the current or previous school year(s). All vehicles parked on school grounds are subject to search. Consequences for Violations of Rules: A student may be referred to the PSLO for a citation at any time. Repeated violations may result in vehicles being towed at owner’s expense. Continued or serious violations may lead to loss of permit as determined by Administration of PSLO. PLEASE READ ENTIRE APPLICATION BEFORE SIGNING. I have read and understand the Parking Permit Application and agree to abide by all of the information contained therein. I further certify that if I have not understood any information contained in this document, I have sought and received an explanation of the information prior to signing this statement. As a student, I understand that having a parking permit is a privilege and, therefore, agree that I am bound by the Kaukauna Area School District Policy 443.8-Suspicionless Random Drug Testing. I agree to participate in suspicionless random drug testing and give permission for testing and the release to the district concerning the results of said testing in the event I am randomly selected. I understand this agreement is binding through my graduation from high school. STUDENT NAME (Please Print_____________________________________________________________________ GRADE: __________ Student’s signature:
Date:
As a parent, I understand that having a parking permit is a privilege and, therefore, agree that my son/daughter is bound by the Kaukauna Area School District Policy 443.8-Suspicionless Random Drug Testing. I give my permission for my son/daughter to participate in suspicionless random drug testing and give permission for testing and the release to the district concerning the results of said testing in the event he/she is randomly selected. I understand this agreement is binding through my son/daughter’s graduation from high school. Parent’s signature: OFFICE USE ONLY: Permit Number issued:
Date:
KAUKAUNA HIGH SCHOOL 1701 County Road CE; Kaukauna, Wisconsin 54130-3916 Office (920) 766-6113 • Fax (920) 766-6157 COREY BAUMGARTNER Principal
JOSHUA CHUDACOFF
CHRIS MCDANIEL
MICHELLE VRANEY
Associate Principal
Activities Director
Associate Principal
Dear Parents, The physical and mental health of young people plays a key role in their ability to succeed in school, have rewarding relationships with family members and friends, and lead productive and happy lives. Kaukauna Area School District is committed to working with you not only to educate your children, but also to ensure that they reach their full potential outside of the classroom. To that end, in the 2017-18 school year, we are offering parents of ninth grade students the opportunity to have their teens participate in an emotional wellness check-up called Connected Community Wellness Screen, which uses a nationally-recognized screening tool. The screening program is free and completely voluntary and confidential. The teen years are a time of tremendous change. Connected Community Wellness Screen can help parents better understand the changes their teens are experiencing. No matter what the results of your teen’s screening are, the program will provide you with important information. For most parents, this screening will reassure you that your teen is just experiencing the typical “roller coaster” of emotions. For other parents, Connected Community Wellness Screen can help you pinpoint a problem in its early stages; giving you the ability to secure needed help for your teen and reduce the chance that a more significant problem will develop in the future. I hope you will take advantage of this confidential check-up. Please read the information below and in the attached “Common Questions and Answers about Connected Community Wellness Screen” and then sign and return the Parent Consent Form on the next page to indicate whether you want your teen to participate. How Does Wellness Screen Work? Jen Parsons, Program Coordinator of Connected Community Wellness Screen will be in charge of the program. It will take place during school hours in a semi-private setting at the school starting in January 2018 for the remainder of the school year. Your teen will not be screened without your permission. All screening results will be kept confidential, stored separately from academic records, and not shared with your teen’s teachers. There are three steps to the screening procedure: Step One: Teens complete a 10-minute questionnaire about vision, hearing and dental problems, symptoms of depression and anxiety, suicidal thinking and behavior, attentional problems and disruptive behavior, and use of drugs and alcohol. Step Two: Teens whose answers reveal a potential problem and teens who ask for help then meet with a trained mental health professional in private to determine if further evaluation would be helpful. Teens whose answers show they probably do not need help meet briefly with other program staff to answer any questions they may have about the program and to give them the opportunity to ask for help with any other concerns the screening did not cover. Step Three: You will be contacted by program staff only if your teen meets with a member of our clinical screening staff. If this is the case, program staff will share the overall results with you and discuss ways you can get help for your teen. You will not be contacted if your teen is not found to need additional mental health services. If a vision, hearing or dental need is identified during the screening process, program staff will share this information with the school nurse. Kaukauna Area School District provides this screening at no cost, but does not provide further evaluation or treatment services. It is up to you to decide if you want to obtain any additional services for your teen. Please do not hesitate to call Jen Parsons at 920-886-9319 x109 if you have any questions. You may also find information about the Connected Community Wellness Screen program at http://www.samaritan-counseling.com. Sincerely, Corey Baumgartner Principal, Kaukauna High School
KAUKAUNA STRONG
Common Questions and Answers about Connected Community Wellness Screen(CCWS) Are CCWS results confidential? Yes, screening is confidential. In order to protect your child’s privacy, his/her screening results and related files will be stored separately from his/her academic records. School staff will not be involved in the screening procedure. If program staff believes that your child is in some danger or is a danger to others, they are mandated by law to take action and notify appropriate personnel and/or necessary authorities. What information will be shared with my child during the screening process? Upon completing the questionnaire the students meet privately with program staff to: discuss any thoughts or concerns that came up for the teens while completing the screen that they would like to discuss; the staff explores with the teen resources they have that they could go to for help if needed; and to obtain their feedback about the screening experience. Teens whose answers to the screening questionnaire reveal potential concerns about their emotional well-being will meet privately with a health professional. The teen and health professional explore symptoms that came to light through the questionnaire, find out how the symptoms are impacting the teen’s life and, if so, determine whether he/ she might benefit from a more complete evaluation by a mental health or medical professional at a later date. At the end of the private meeting, if the health professional has determined that a teen might benefit from such an evaluation, the teen will be told that his/ her parent(s) will be contacted to discuss a recommendation for follow-up. What if I provide consent, but my child doesn’t want to participate? Because we believe screening should be completely voluntary, your child may refuse to participate or refuse to answer any questions during the screening. We will follow up with the parents and inform you if your child chooses not to participate or is absent on the day of the screening. You and your child can decide to participate at a later date as well. Does CCWS recommend treatment? The Connected Community Wellness Screen Program and staff do not make any treatment recommendations. All possible treatment decisions are made by families in close consultation with a health professional of your choice after the recommendation for the further evaluation. Treatment recommendations are beyond the scope of the CCWS. How accurate is the screening questionnaire? The Pediatric Symptom Checklist-Youth Self-Report (PSC-Y) was developed by Massachusetts General Hospital and research has concluded that it is effective in identifying youth with possible emotional wellness impairment. However, the questionnaire results are not a medical diagnosis. Medical diagnoses are beyond the scope of the screening program. Can I see the questionnaire? Yes. If you wish to review the CCWS questionnaire, the assent form your child will be asked to sign prior to his/her participation in the program, or any instructional materials related to the screening, please do not hesitate to contact Jen Parsons 886-9319 x109, who will gladly assist you. Where does CCSW get its support? The program is supported by local community foundations. It is operated as a nonprofit public service and accepts individual donations to help offset the cost of screening services to local communities. The program receives no funding from pharmaceutical companies.
KAUKAUNA STRONG
Parent Consent Form Please return this form indicating if you would like your teen to participate in the screening. You may mail this form to the address below; have your teen deliver it to the school office or email to Jen Parsons directly at
[email protected]. Jen Parsons- Wellness Screening 1478 Kenwood Dr., Suite 1 Menasha, WI 54952 I read the description of the Connected Community Wellness Screen (CCWS) program and understand that CCWS: is free, confidential and voluntary does not diagnose or recommend any particular type of treatment uses the Pediatric Symptom Checklist-Youth (PSC-Y) which helps identify emotional wellness impairment and that the school district and the Wellness Screen Program cannot guarantee the PSC-Y will always identify every emotional wellness impairment I would like my child to participate in the Connected Community Wellness Screen Program I do not want my child to participate in the Connected Community Wellness Screen Program
Parent/Guardian Name (Print): Teen’s Name (Print):
Grade:
Parent/Guardian Signature: Date:
School your teen attends:
If your teen will be participating, please provide the following information so we can contact you if necessary: Address:
Home Phone #: Cell Phone #:
Email Address: *by providing your email address you will receive quarterly newsletter updates regarding updated teen mental health information
Best times to reach you: 1) 2)
Tel. #: Tel. #:
KAUKAUNA STRONG
Attendance at KHS: URGENT Kaukauna High School is excited for the 2017-2018 school year and we have high expectations for your child’s learning and growth. A key component to classroom success is regular school attendance. A review of student attendance data by the Wisconsin Department of Public Instruction shows that regular school attendance is essential to successful learning. High attendance rates are linked to high student achievement. Every day counts. Missing school even 10% of the time has a significant negative impact on reading and math achievement. A student may be chronically absent if he or she misses just two days every month, regardless of the reason. The evidence is clear:
Students with good attendance are more likely to be successful in school. As KHS studied attendance data from the past five years, we noticed a significant negative trend. Our unexcused absence numbers are climbing at an alarming rate and we need to enlist your help to reduce truancy and tardiness. When kids are absent from class, they are missing out on valuable teaching and learning opportunities. This, in turn, can impact their academic success. If a student arrives to class more than 10 minutes late without an acceptable parent or medical excuse, he or she is absent unexcused (or truant). The table below demonstrates the total number of days absent (both unexcused and excused) as well as the total number of unexcused tardies for the past five years. You will notice the number of unexcused absent days has more than doubled in the past three years. Unexcused Absent Days
Excused Absent Days
Unexcused Tardies
2016-2017
4,239
7,617
6,356
2015-2016
3,150
7,400
6,956
2014-2015
2,219
7,389
6,335
2013-2014
1,736
7,705
5,801
2012-2013
1,746
7,324
5,574
We realize some absences are unavoidable due to health related concerns, appointments or other circumstances. Parents and guardians are authorized to excuse their child from school for up to a maximum of 10 days in a school year, provided they notify the school. Please call the attendance line stating the reason for the absence at (920)766-6113, and press 5. Messages can be left 24 hours a day. If your child has a wellness appointment (e.g. chiropractor, doctor, dentist, orthodontist, therapist, counselor, etc.), please obtain a signed medical note, stating the date and time your child was seen. Bringing a medical note to the front office within 10 business days will allow KHS to code your child’s absence as “medically excused”. When your child is “medically excused”, that absence does not count against your 10 days mentioned above. We will be closely monitoring and reporting our student attendance this year. We appreciate our partnerships with our KHS families to ensure students are on a path to individual success, which starts with great attendance. Additionally, we realize that every family faces challenges. KHS wants to support your family to ensure your child’s attendance stays on track. Please contact me if you have any questions or if we can help your family with maintaining good school attendance. Best wishes for a successful school year!
Michelle Vraney Associate Principal Kaukauna High School
[email protected] (920)766-6113 Ext. 6153
2017-2018 Student Cell Phone Usage Starting with the 2017-2018 school year we are very excited that all freshmen, sophomores and juniors will be issued an individual Chromebook for use both inside and outside of school. The Chromebook is a tool to transform the educational process for students. While technology can certainly enhance a student’s education, school administration and educational staff have unfortunately noticed that cell phone usage by students has become a big distraction and disruption to the learning environment during the past three school years. In an effort to help our students be able to focus on their learning and unlock the full potential of the Chromebooks, we will continue to concentrate on the enforcement of our board of education policy regarding cell phone usage, which reads as follows: “Devices may not be used for non-instructional purposes during instructional time or any other time as determined by the building principal.” Therefore, we are going to require that no cell phones be used or visible in classrooms or learning environments this year. Since only students in grades 9-11 are being issued Chromebooks, there will be times that our incoming seniors will need to use a device for educational purposes. In those instances, our staff will provide them with access to the necessary electronic devices within the classroom setting to support their learning if they do not have one available. Students will still be allowed to use their cell phones in the halls and the commons during our 8-minute passing time, before school, at lunch or after school. Please keep in mind that calling or texting your son or daughter during the school day has the potential to disrupt the learning environment. If you need to reach your son or daughter while they are at school, please contact the main office at 920-766-6113 and we will communicate the important information to them. In an emergency situation, we will be able to contact your son or daughter immediately. Please refer to the Cell Phone Use in the Classroom section under Student Policies and Procedures in the student handbook for specific details regarding cell phone procedures and potential consequences. Thank you very much for your continued support of your student’s learning. If you have any questions in regard to this topic please feel free to contact us.
Josh Chudacoff Associate Principal (920) 766-6113 Ext. 6152
[email protected]
Michelle Vraney Associate Principal (920) 766-6113 Ext. 6153
[email protected]
Parents’ Guide to
School Lunch 2017-2018 The Kaukauna Area School District participates in the National School Lunch Program under a contract with Chartwells School Dining Service. Students may purchase lunch every day or as often as they like. Students may bring a cold lunch if they prefer. We aim for our lunch program to be simple-to-use, appealing, and nutritious. Please consult this flyer for lunch program guidelines. cafeteria and may select up to 4 of the food items offered. Our Goal *Breakfast Prices Menus are planned with a goal of providing Elementary $1.55 a variety of nourishing items at an River View Middle School $1.80 affordable price. Community food Kaukauna High School $1.80 preferences are considered so that students will like the choices that are offered. The Lunch Menu Students are encouraged to try different A nutritious lunch is provided every school foods and to use the cafeteria as a learning day in all schools. A reimbursable lunch laboratory for making nutritious choices. consists of an entrée (protein), vegetable, fruit, grains, and milk. Students may select Offer-versus-Serve three, four, or five of the offered items with KASD provides Offer-versus-Serve, which one being a fruit or vegetable to make a is a serving method that allows students to reimbursable meal. take foods that they will eat. The intent of Offer-versus-Serve is to allow students the Elementary Schools offer an entree, fresh right to refuse food items they do not like or and frozen vegetables, canned and fresh do not plan on eating with the exception fruits and milk. Extra milk is available to being that students must take one fruit or purchase for $0.40. vegetable to comply with USDA guidelines. Offer-versus-Serve helps increase student River View Middle School and Kaukauna acceptability and decrease food waste. High School offer a choice of hot entrées,
The Breakfast Menu Breakfast is offered at all schools. All Elementary schools offer Breakfast in the Classroom. High school and Middle school students have breakfast offered in the
hot sandwiches, deli subs, wraps, salads, vegetables, canned and fresh fruits and milk. *Lunch Prices for reimbursable meal Elementary $2.70 River View Middle School $2.95 Kaukauna High School $2.95 Premium Meal $3.45
A la carte option: the a la carte option at River View Middle School and Kaukauna High School consists of individual sales of various snacks, fresh fruits, vegetables, juice, water, milk and dessert items.
To ensure your child has lunch and breakfast waiting… *Pre-pay for meals with Cash Check or On-Line Payments The KASD suggests that parents pay in advance for school meals and milk. You can send cash or check on a weekly, monthly, or semester basis for deposit in the Student Lunch Account. You may also pay on-line using the Parent Portal System. Put cash or a check (payable to the KASD) in an envelope. On a separate sheet OR on the outside of the envelope, write the names of your children and their Student ID Numbers. Put the envelope in the locked drop box by each school office. OR, mail your lunch money to: KASD Dining Services 1701 Cty Hwy CE Kaukauna, WI 54130 To have money in your child’s account on the first day of school, please make a deposit by September 1, 2017. During the school year, money received in the morning will be recorded in time for the next day’s lunch. Students who qualify for free or reduced-price meals get one reimbursable breakfast and lunch each day. This does not include milk for someone bringing a cold lunch. To purchase second helpings or ala carte items, students getting free and reducedprice meals must pay cash or parent may put extra money in the Student Account please call Dining Services at 920-7596122.
1.
2.
Keeping track of your account balance If you have an email address or phone number listed in the Parent Portal, we will send you an email notice or a phone call when your account balance has reached +$5.00. Email notices and phone calls will be sent daily. River View School and Kaukauna High School students may ask about their account balance any time they go through the lunch line.
Website To access the Chartwells Dining Services Website, go to the KASD website at www.kaukauna.k12.wi.us. After you have accessed the district’s website move to the right hand side of the home page under the Quick Links area, click on Food Service and Menus link. You will be able to access all school menus, school dining information, news about Chartwells and links to health and nutritional information.
Good Deal on Meals The average school lunch costs more than $2.95 to prepare and serve. The United States Department of Agriculture donates commodities and federal and state funds make up the difference between what the lunch costs to produce and what students pay. The subsidized school lunch is less expensive than a lunch of equal nutritional value prepared and packed at home.
Adults and Visitors Pay a Bit More Because federal reimbursements and commodities are not received for lunches sold to visitors or school staff, visitors pay more for the food than students. However, the cost is significantly less than what people pay at a restaurant for the same type or amount of food.
Non-Discrimination Statement In accordance with Federal law and U.S. Department of Agriculture policy, KASD 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 Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue SW, Washington, D.C. 20250-9410 or call 202-7205964 (voice and TDD). USDA is an equal opportunity provider and employer.
Employment Opportunities Job applicants may contact Chartwells with KASD National School Lunch Program by calling 920-759-6122.
Join your Child for Lunch If you plan to join your child for breakfast or lunch any day, please call the school office by 8 a.m. Your child’s account will be charged $3.65 for lunch or $2.10 for breakfast or you may pay cash.
National School Lunch Program Guides KASD Meal Service The KASD participates in the National School Lunch (NSL) and School Breakfast Programs. The United States Department of Agriculture administers these programs and has established guidelines that must be followed by the District. NSL guidelines specify the type of meal to be served and the quantities of each food that must be offered. The school lunch provides 1/3 of the Recommended Daily Dietary Allowances for key nutrients as well as sufficient calories to provide for the energy needs of growing children. An emphasis is placed on providing calories from whole grain breads, vegetables, and fresh fruits. Low fat milk is offered. Recipes have been revised to lower the amount of fat, sugar and salt. The nutritive value of products is evaluated so healthy choices are available to students.
Got Milk?
Allergies If your child has any food related allergies, you must contact your school nurse and forward any medical information and forms yearly to the Dining Services Office for consideration.
All reimbursable meals include one carton of milk. Extra milk costs 40¢ Important Numbers… Leslie Willems Pam Mischler Bob Schafer Mark Duerwaechter
Chartwells Dining Service Director …920-759-6121 Dining Services Office……………….. 920-759-6122 Financial Officer…………………….....920-759-6104 District Administrator……………….…920-766-6100
SSh! If you qualify for free meals, it will be our little secret! Your child may be eligible for free and reduced-price meals Free and reduced-price lunches are available if your family qualifies based on family size and income as established by federal guidelines. Reduced-priced breakfast is 30¢ and reduced-priced lunch grade is 40¢ for all grade levels. This includes one milk with each breakfast or lunch.
An application must be filled out every year. You may apply at any time during the school year. The On-Line application process is now available on the District web page. If you do not have internet access you may contact your child’s school to obtain an application or by contacting Chartwells at 920-759-6122.
To qualify for free or reduced-priced meals by the first day of school on September 5, applications should be submitted by August 25 to allow time for processing.
Application forms for free and reduced-priced meals will be on the district website any time during the school year.
Continuing students who received free or reducedpriced meals at the end of the 2016-17 school year will continue to receive free or reduced-priced meals thru September 2017 only. To re-qualify for the remainder of 20172018, families must submit a new application before September 15, 2017.
For questions or information about free and reduced-price meals, please call 920-759-6122.
Tips for completing the free and reduced-price application If you are currently receiving Foodshare, TANF (Temporary Assistance for Needy Families), or FDPIR (Food Distribution Program on Indian Reservations), the only information required is your child’s name, the Foodshare, TANF, or FDPIR case number, and your signature. If you are not receiving any of the above benefits, your application must include the names of all household members and the current amount of income received by each member. Additionally, you must sign the application and include your social security number. Once the application is returned to the school, you can expect to be contacted within about 10 days. If you are not contacted within 20 days, call Pam Mischler at 920759-6122 to ask about the status of your application.
Who can qualify for free or reduced meals? There are two ways to qualify. 1. If you currently receive Foodshare, TANF, or participate in FDPIR, your child is eligible for free school meals for as long as you receive these benefits. 2. If your household’s total income is below certain amounts, your child can eat free or at a much reduced price.
**Please Remember—If your student qualifies for Free or Reduced Price Meal that also includes Breakfast!!
You can now access the free and reduced application online! Go to the Kaukauna Area School District website at www.kaukauna.k12.wi.us. If you have a parent portal account, sign in to your Parent Portal account. You can then access the application by clicking on APPLICATIONS/FORMS and following the instructions provided. If you do not have a Parent Portal account, you can set one up by going to the district website and clicking on the following tabs: Family Resources…Technology Tools…Need a Parent Portal Account. Follow the instructions provided. Once you have Parent Portal account, you can then access the online application for free and reduced by clicking on APPLICATIONS/FORMS and following the instructions. The Kaukauna Area School District encourages the use of the online application process to save on time and paperwork. However, you may download the application and send the completed forms to KASD/Chartwells Dining Services, 1701 Cty Hwy CE, Kaukauna, WI 54130. If you do not have access to a computer, you may request an application from your student’s school or by calling KASD/Chartwells Dining Services at 920-759-6122 and an application will be sent to you. The online application for the 2017/2018 school year will be available August 15th, 2017
FREQUENTLY ASKED QUESTIONS ABOUT FREE AND REDUCED PRICE SCHOOL MEALS FOR SCHOOL YEAR 2017-18 Dear Parent/Guardian: Children need healthy meals to learn. The Kaukauna Area School District offers healthy meals every school day. Elementary breakfast is $1.55, secondary breakfast is $1.80, elementary lunch is $2.70, secondary lunch is $2.95. Your children may qualify for free meals or for reduced price meals. Reduced price is $.30 for breakfast and $.40 for lunch. This packet includes an application for free or reduced price meal benefits, and a set of detailed instructions. Below are some common questions and answers to help you with the application process. 1.
WHO CAN GET FREE OR REDUCED PRICE MEALS? • All children in households receiving benefits from FoodShare, the Food Distribution Program on Indian Reservations (FDPIR)], or W-2 cash benefits are eligible for free meals. • Children in households that receive Medicare benefits may qualify for free or reduced price meals. • Foster children that are under the legal responsibility of a foster care agency or court are eligible for free meals. • Children participating in their school’s Head Start program are eligible for free meals. • Children who meet the definition of homeless, runaway, or migrant are eligible for free meals. • Children may receive free or reduced price meals if your household’s income is within the limits on the Federal Income Eligibility Guidelines. Your children may qualify for free or reduced price meals if your household income falls at or below the limits on this chart. FEDERAL ELIGIBILITY INCOME CHART For School Year 2017-2018 Household size Yearly ($) Monthly ($) 1 22,311 1,860 2 30,044 2,504 3 37,777 3,149 4 5 6 7 8 Each additional person:
45,510 53,243 60,976 68,709 76,442 7,733
3,793 4,437 5,082 5,726 6,371 645
Weekly ($) 430 578 727 876 1,024 1,173 1,322 1,471 149
2. HOW DO I KNOW IF MY CHILDREN QUALIFY AS HOMELESS, MIGRANT, OR RUNAWAY? Do the members of your household lack a permanent address? Are you staying together in a shelter, hotel, or other temporary housing arrangement? Does your family relocate on a seasonal basis? Are any children living with you who have chosen to leave their prior family or household? If you believe children in your household meet these descriptions and have not been told your children will get free meals, please call or email Karen Wirth at 920-766-6134 or
[email protected] .
3.
DO I NEED TO FILL OUT AN APPLICATION FOR EACH CHILD? No. Use one Free and Reduced Price School Meals Application for all students in your household. We cannot approve an application that is not complete, so be sure to fill out all required information. Return the completed application to: Pam Mischler, 1701 Cty Hwy CE, Kaukauna, WI 54130.
4.
SHOULD I FILL OUT AN APPLICATION IF I RECEIVED A LETTER THIS SCHOOL YEAR SAYING MY CHILDREN ARE ALREADY APPROVED FOR FREE OR REDUCED PRICE MEALS? No, but please read the letter you got carefully and follow the instructions. If any children in your household were missing from your eligibility notification, contact Pam Mischler,
1701 Cty Hwy CE, Kaukauna, WI 54130 or 920-759-6122 or
[email protected] immediately. If your household has automatically qualified for reduced meals based on Medicare, we encourage you to complete an application to potentially qualify for free meals based on household size and income. 5.
DO I NEED TO FILL OUT AN APPLICATION IF MY CHILD ATTENDS A COMMUNITY ELIGIBILITY PROVISION SCHOOL (CEP)? If your child attends a school that participates in CEP, receipt of free breakfast and lunch meals does not depend on returning this application. However, this information is necessary for other programs and may be used to determine if your household is eligible for additional benefits.
6.
CAN I APPLY ONLINE? Yes! You are encouraged to complete an online application instead of a paper application if you are able. The online application has the same requirements and will ask you for the same information as the paper application. Visit www.kaukauna.k12.wi.us to begin or to learn more about the online application process. Contact Pam Mischler, 1701 Cty Hwy CE, Kaukauna, WI 54130, 920-759-6122, or
[email protected]. if you have any questions about the online application.
7.
MY CHILD’S APPLICATION WAS APPROVED LAST YEAR. DO I NEED TO FILL OUT A NEW ONE? Yes. Your child’s application is only good for that school year and for the first few days of this school year, through October 16, 2017. You must send in a new application unless the school told you that your child is eligible for the new school year. If you do not send in a new application that is approved by the school or you have not been notified that your child is eligible for free meals, your child will be charged the full price for meals.
8.
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 send in an application.
9.
WILL THE INFORMATION I GIVE BE CHECKED? Yes. We may also ask you to send written proof of the household income you report.
10. IF I DON’T QUALIFY NOW, MAY I APPLY LATER? Yes, you may apply at any time during the school year. For example, children with a parent or guardian who becomes unemployed may become eligible for free and reduced price meals if the household income drops below the income limit. 11. WHAT IF I DISAGREE WITH THE SCHOOL’S DECISION ABOUT MY APPLICATION? You should talk to school officials. You also may ask for a hearing by calling or writing to: Bob Schafer, 1701 Cty Hwy CE, Kaukauna, WI 54130, or 920-766-6100,
[email protected]. 12. MAY I APPLY IF SOMEONE IN MY HOUSEHOLD IS NOT A U.S. CITIZEN? Yes. You, your children, or other household members do not have to be U.S. citizens to apply for free or reduced price meals. 13. WHAT IF MY INCOME IS NOT ALWAYS THE SAME? List the amount that you normally receive. For example, if you normally make $1000 each month, but you missed some work last month and only made $900, put down that you made $1000 per month. If you normally get overtime, include it, but do not include it if you only work overtime sometimes. If you have lost a job or had your hours or wages reduced, use your current income. 14. WHAT IF SOME HOUSEHOLD MEMBERS HAVE NO INCOME TO REPORT? Household members may not receive some types of income we ask you to report on the application, or may not receive income at all. Whenever this happens, please write a 0 in the field. However, if any income fields are left empty or blank, those will also be counted as zeroes. Please be careful when leaving income fields blank, as we will assume you meant to do so. 15. WE ARE IN THE MILITARY. DO WE REPORT OUR INCOME DIFFERENTLY? Your basic pay and cash bonuses must be reported as income. If you get any cash value allowances for off-base housing, food, or clothing, it must also be included as income. However, if your housing is part of the Military Housing Privatization Initiative, do not include your housing allowance as income. Do not include any combat pay resulting from deployment as income. 16. WHAT IF THERE IS NOT ENOUGH SPACE ON THE APPLICATION FOR MY FAMILY? List any additional household members on a separate piece of paper and attach it to your application.
17. MY FAMILY NEEDS MORE HELP. ARE THERE OTHER PROGRAMS WE MIGHT APPLY FOR? To find out how to apply for FoodShare or other assistance benefits, contact your local assistance office or call 1-800-362-3002. If you have other questions or need help, call 9 20 - 75 9 -6 1 22 . Sincerely, Pam Mischler Free and Reduced Coordinator/KASD Chartwells Dining Services
HOW TO APPLY FOR FREE AND REDUCED PRICE SCHOOL MEALS for 2017-18 School Year Please use these instructions to help you fill out the application for free or reduced price school meals. You only need to submit one application per household, even if your children attend more than one school in the Kaukauna Area School District. The application must be filled out completely to certify your children for free or reduced price school meals. Please follow these instructions in order. If at any time you are not sure what to do next, please contact KASD/Pam Mischler, 920-759-6122,
[email protected]. If your child attends a Community Eligibility Provision School (CEP), receipt of free breakfast and lunch meals does not depend on returning this application; however, this information is necessary for other programs.
PLEASE USE A PEN (NOT A PENCIL) WHEN FILLING OUT THE APPLICATION AND DO YOUR BEST TO PRINT CLEARLY.
STEP 1: LIST ALL HOUSEHOLD MEMBERS WHO ARE INFANTS, CHILDREN, AND STUDENTS UP TO AND INCLUDING GRADE 12 Tell us how many infants, children, and school students live in your household. They do NOT have to be related to you to be a part of your household. Who should I list here? When filling out this section, please include ALL members in your household who are: • Children age 18 or under AND are supported with the household’s income; • In your care under a foster arrangement, or qualify as homeless, migrant, or runaway youth, or enrolled in a Head Start program; and • Students attending a public school in the Kaukauna Area School District, regardless of age. A) List each child’s name. Print each child’s B) Enter the grade and the C) Do you have any foster children? If any children D) Are any children homeless, name. Use one line of the application for each listed are foster children, mark the “Foster Child” box name of the school the child migrant, runaway or enrolled in a child. When printing names, write one letter in attends or mark n/a if not in next to the children’s names. If you are ONLY applying Head Start program? If you believe any each box. Stop if you run out of space. If there for foster children, after finishing STEP 1, go to STEP child listed in this section meets this school. Enter the grade level of the are more children present than lines on the 4. description, mark the “Homeless, Migrant, student in the ‘Grade’ column. application, attach a second piece of paper Foster children who live with you may count as Runaway or Head Start” box next to the with all required information for the members of your household and should be listed on child’s name and complete all steps of the additional children. your application. If you are applying for both foster application. and non-foster children, go to step 3.
STEP 2: DO ANY HOUSEHOLD MEMBERS CURRENTLY PARTICIPATE IN FoodShare, W-2 Cash Benefits OR FDPIR? If anyone in your household (including you) currently participates in one or more of the assistance programs listed below, your children are eligible for free school meals: • The Supplemental Nutrition Assistance Program (SNAP) or FoodShare. • Temporary Assistance for Needy Families (TANF) or W-2 Cash Benefits. • The Food Distribution Program on Indian Reservations (FDPIR). A) If no one in your household participates in any of the B) If anyone in your household participates in any of the above listed programs: above listed programs: • Write a case number for FoodShare, W-2 Cash Benefits, or FDPIR. You only need to provide one case number. If you participate in one of these programs and do not know your case number, contact your case worker. Please • Leave STEP 2 blank and go to STEP 3. note, a BadgerCare case number does NOT qualify for free meals. • Go to STEP 4.
STEP 3: REPORT INCOME FOR ALL HOUSEHOLD MEMBERS How do I report my income? • •
Use the charts titled “Sources of Income for Children” and “Sources of Income for Adults,” printed on the back side of the application form, to determine if your household has income to report. Report all amounts in GROSS INCOME ONLY. Report all income in whole dollars. Do not include cents. Gross income is the total income received before taxes. Many people think of income as the amount they “take home” and not the total, “gross” amount. Make sure that the income you report on this application has NOT been reduced to pay for
• •
taxes, insurance premiums, or any other amounts taken from your pay. Write a “0” in any fields where there is no income to report. Any income fields left empty or blank will also be counted as a zero. If you write ‘0’ or leave any fields blank, you are certifying (promising) that there is no income to report. If local officials suspect that your household income was reported incorrectly, your application will be investigated. Mark how often each type of income is received using the circles to the right of each field.
3.A. REPORT INCOME EARNED BY CHILDREN A) Report all income earned or received by children. Report the combined gross income for ALL children listed in STEP 1 in your household in the box marked “Child Income.” Only count foster children’s personal income if you are applying for them together with the rest of your household. What is Child Income? Child income is money received from outside your household that is paid DIRECTLY to your children. Many households do not have any child income.
3.B. REPORT INCOME EARNED BY ADULTS List adult household members’ names. • Print the name of each household member in the boxes marked “Name of Adult Household Members (First and Last).” When filling out this section, please include ALL adult members in your household who are living with you and share income and expenses, even if they are not related and even if they do not receive income of their own. • Do NOT include: o People who live with you but are not supported by your household’s income AND do not contribute income to your household. o Infants, children and students already listed in STEP 1. C) Report earnings from work. Report all total gross income E) Report income from D) Report income from public assistance/child (before taxes) from work in the “Earnings from Work” field on pensions/retirement/all other income. support/alimony. Report all income that applies in the “Public the application. This is usually the money received from working Report all income that applies in the Assistance/Child Support/Alimony” field on the application. Do not at jobs. If you are a self-employed business or farm owner, you “Pensions/Retirement/ All Other Income” field report the cash value of any public assistance benefits NOT listed on will report your net income. on the application. the chart. If income is received from child support or alimony, only report court-ordered payments. Informal but regular payments What if I am self-employed? Report income from that work as a should be reported as “other” income in the next part. net amount. This is calculated by subtracting the total operating expenses of your business from its gross receipts or revenue. G) Report total household size. Enter the total number of H) Provide the last four digits of your F) Fluctuating Income. For seasonal workers and others whose household members in the field “Total Household Members (Children Social Security Number (SSN). An adult income fluctuates and usually earn more money in some months and Adults).” This number MUST be equal to the number of household household member must enter the last four than others. In these situations, project the annual rate of income members listed in STEP 1 and STEP 3. If there are any members of digits of their SSN in the space provided. You and report that. This includes workers with annual employment your household that you have not listed on the application, go back are eligible to apply for benefits even if you do contracts but may choose to have salaries paid over a shorter and add them. It is very important to list all household members, as not have a SSN. If no adult household members period of time; for example, school employees. the size of your household affects your eligibility for free and reduced have a SSN, leave this space blank and mark the price meals. box to the right labeled “Check if no SSN.”
STEP 4: CONTACT INFORMATION AND ADULT SIGNATURE An adult member of the household must sign the application. By signing the application, that household member is promising that all information has been truthfully and completely reported. Before completing this section, please also make sure you have read the privacy and civil rights statements on the back of the application. A) Provide your contact information. Write your B) Print and sign your C) Return completed D) Share children’s racial and ethnic identities current address in the fields provided if this information name. Print the name of the form to: KASD/Food (optional). On the back of the application, we ask is available. If you have no permanent address, this does adult signing the application Service, 1701 Cty you to share information about your children’s race not make your children ineligible for free or reduced price and that person signs in the Hwy CE, Kaukauna, and ethnicity. This field is optional and does not school meals. Sharing a phone number, email address, or box “Signature of adult.” WI 54130 affect your children’s eligibility for free or reduced both is optional, but helps us reach you quickly if we need price school meals. to contact you.
2017-2018 Household Application for Free and Reduced Price School Meals
Apply online at: www.kaukauna.k12.wi.us.com
Complete one application per household. Please use a pen (not a pencil).
STEP 1
List ALL infants, children, and students up to and including grade 12 who are Household Members
If more spaces are required for additional names, attach another sheet of paper.
Definition of Household Member: “Anyone who is living with you and shares income and expenses, even if not related.”
MI
School the child attends or NA if not in school
Grade
Child’s Last Name
Foster Child
Homeless, Migrant, Head Runaway Start
Check all that apply
Child’s First Name
STEP 2
Do any Household Members (including you) currently participate in any of the following assistance programs: FoodShare, W-2 Cash Benefits, or FDPIR? Case Number
Yes /
No
Program Name
If you answered NO > Complete STEP 3. If you answered YES > Write a case number here, then go to STEP 4 (Do not complete STEP 3) Write only one case number in this space.
STEP 3
Report Income for ALL Household Members (skip this step if you answered ‘Yes’ to STEP 2)
Badger Care does not qualify for free meals.
Flip the page and review the charts titled “Sources of Income” for more information. How often?
A. Child Income
Child income
Sometimes children in the household earn income. Please include the TOTAL income earned by all infants, children and students up to and including grade 12 listed in STEP 1 here.
B. All Adult Household Members (including yourself)
Weekly
Bi-Weekly
2x Month Monthly
$
List all Household Members not listed in STEP 1 (including yourself) even if they do not receive income. For each Household Member listed, if they do receive income, report total gross income (before taxes) for each source in whole dollars only (no cents). If they do not receive income from any source, write ‘0’. If you enter ‘0’ or leave any fields blank, you are certifying (promising) that there is no income to report. Name of Adult Household Members (First and Last Name)
C.
How often? Earnings from Work
Child Support/ Alimony/SSI/VA Benefit
How often?
E. Pensions/Retirement/ Social Security, Other Income
Weekly Bi-Weekly 2x Month Monthly
F.
How often? Weekly Bi-Weekly 2x Month Monthly
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
G. Total Household Members (Children and Adults)—
H. Last Four Digits of Social Security Number (SSN) of Primary Wage Earner or Other Adult Household Member—REQUIRED or check box if no SSN
REQUIRED
STEP 4
Weekly Bi-Weekly 2x Month Monthly
D. Public Assistance/
Contact information and adult signature
Return completed form to:
X X X
X X
Seasonal Workers, and others with fluctuating income, project the annual income and report here.
Check if no SSN
KASD/Food Service, 1701 Cty Hwy CE, Kaukauna WI 54130
“I certify (promise) that all information on this application is true and that all income is reported. I understand that this information is given in connection with the receipt of Federal funds, and that school officials may verify (check) the information. I am aware that if I purposely give false information, my children may lose meal benefits, and I may be prosecuted under applicable State and Federal laws.”
KASD Street Address (if available)
Apt #
Printed Name OR Signature of Adult Completing this Application—REQUIRED
City
State
Zip
Daytime Phone and Email (optional)
Today’s Date Mo./Day/Yr.
INSTRUCTIONS
Source of Income
Sources of Income for Adults
Sources of Income for Children Example(s)
Sources of Child Income - Gross earnings from work
- A child has a regular full or part-time job where they earn a salary or wages
- Social Security - Disability payments - Survivor’s benefits - Income from person outside the household
- A child is blind or disabled and receives Social Security benefits - A parent is disabled, retired, or deceased, and their child receives Social Security benefits - A friend or extended family member regularly gives a child spending money
- Income from any other source
- A child receives regular income from a private pension fund, annuity, or trust
OPTIONAL
Public Assistance / Alimony / Child Support
Earnings from Work - Gross salary, wages, cash bonuses - Net income from self-employment (farm or business); FARM—refer to line 18 of the 1040 or line 34 from Schedule F; BUSINESS—refer to line 12 of 1040 or line 31 from Schedule C. If you are in the U.S. Military: - Basic pay and cash bonuses (do NOT include combat pay, FSSA or privatized housing allowances) - Allowances for off-base housing, food and clothing
- Unemployment benefits - Worker’s compensation - Supplemental Security
Income (SSI)
- Cash assistance from -
State or local government Alimony payments Child support payments Veteran’s benefits Strike benefits
Pensions / Retirement / All Other Income - Social Security (including railroad -
retirement and black lung benefits) Private pensions or disability benefits Regular income from trusts or estates Annuities Investment income Earned interest Rental income Regular cash payments from outside household
Children’s Racial and Ethnic Identities
We are required to ask for information about your children’s race and ethnicity. This information is important and helps to make sure we are fully serving our community. Responding to this section is optional and does not affect your children’s eligibility for free or reduced price meals. Ethnicity Check one
Hispanic or Latino
Race Check one or more
American Indian or Alaskan Native
Not Hispanic or Latino Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
The Richard B. Russell National School Lunch Act requires the information on this application. You do not have to give the information, but if you do not, we cannot approve your child for free or reduced price meals. You must include the last four digits of the social security number of the adult household member who signs the application. The last four digits of the social security number is not required when you apply on behalf of a foster child or you list a Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) Program or Food Distribution Program on Indian Reservations (FDPIR) case number or other FDPIR identifier for your child or when you indicate that the adult household member signing the application does not have a social security number. We will use your information to determine if your child is eligible for free or reduced price meals, and for administration and enforcement of the lunch and breakfast programs. We MAY share your eligibility information with education, health, and nutrition programs to help them evaluate, fund, or determine benefits for their programs, auditors for program reviews, and law enforcement officials to help them look into violations of program rules.
Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.
Mail:
U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity conducted or funded by USDA.
Fax: Email:
(202) 690-7442; or
[email protected].
Do not fill out
For School Use Only Weekly
Determining Official’s Signature
Bi-Weekly 2x Month
This institution is an equal opportunity provider.
Annual Income Conversion: Weekly x 52, Bi-weekly (Every 2 Weeks) x 26, Twice a Month x 24, Monthly x 12
How often? Total Income
To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:
Monthly
Yearly
Date Mo./Day/Yr.
Household Size
Categorical Eligibility
Confirming Official’s Signature Required for Verification
Eligibility Free
Reduced
Denied
Date Mo./Day/Yr.
Date Denied
Reason for Denial or Withdrawal
Verifying Official’s Signature Required for Verification
Date Mo./Day/Yr.
SHARING INFORMATION WITH OTHER PROGRAMS
Dear Parent/Guardian: To save you time and effort, the information you gave on your Free and Reduced Price School Meals Application may be shared with other programs for which your children may qualify. For the following programs, we must have your permission to share your information. Sending in this form will not change whether your children get free or reduced price meals.
Yes! I DO want school officials to share information from my Free and Reduced Price School Meals Application with school and activity fees.
Yes! I DO want school officials to share information from my Free and Reduced Price School Meals Application with band and choir fees.
Yes! I DO want school officials to share information from my Free and Reduced Price School Meals Application with bussing.
Application with Medicare and/or Badgercare If you checked yes to any or all of the boxes above, fill out the form below to ensure that your information is shared for the child(ren) listed below. Your information will be shared only with the programs you checked. Child's Name: ___________________________________________School:___________________________________________ Child's Name: ___________________________________________School:___________________________________________ Child's Name: ___________________________________________School:___________________________________________ Child's Name: ___________________________________________School:___________________________________________ Signature of Parent/Guardian: ______________________________________________Date: ______________ Printed Name: ________________________________________________________________________________ Address: _____________________________________________________________________________________ _____________________________________________________________________________________________ For more information, you may call Pam Mischler at 920-759-6122 or e-mail at
[email protected]. Return this form to: Kaukauna Area School District/Chartwells 1701 Cty Hwy CE, Kaukauna WI 54130
Free and Reduced Price School Meal Application Sharing Information with Other Programs Page 1 of 3
SHARING INFORMATION WITH MEDICAID/BADGERCARE Dear Parent/Guardian: If your children get free or reduced price school meals, they may also be able to get free or low-cost health insurance through Medicaid or the State Children's Health Insurance Program (BadgerCare). Children with health insurance are more likely to get regular health care and are less likely to miss school because of sickness. Because health insurance is so important to children’s well-being, the law allows us to tell Medicaid and BadgerCare that your children are eligible for free or reduced price meals, unless you tell us not to. Medicaid and BadgerCare only use the information to identify children who may be eligible for their programs. Program officials may contact you and offer to enroll your children. Filling out the Free and Reduced Price School Meals Application does not automatically enroll your children in health insurance. If you do not want us to share your information with Medicaid or BadgerCare, fill out the form below and send in (Sending in this form will not change whether your children get free or reduced price meals).
No! I DO NOT want information from my Free and Reduced Price School Meals Application shared with Medicaid or the State Children's Health Insurance Program (BadgerCare).
If you checked no, fill out the form below to ensure that your information is NOT shared for the child(ren) listed below: Child's Name: ___________________________________________School:___________________________________________ Child's Name: ___________________________________________School:___________________________________________ Child's Name: ___________________________________________School:___________________________________________ Child's Name: ___________________________________________School:___________________________________________ Signature of Parent/Guardian: ______________________________________________Date: ______________ Printed Name:________________________________________________________________________________ Address:_____________________________________________________________________________________ For more information, you may call Pam Mischler at 920-759-6122 or email at
[email protected]. Return this form to: Kaukauna Area School District Attn: Chartwells 1701 Cty Hwy CE Kaukauna, WI 54130
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where Free and Reduced Price School Meal Application Sharing Information with Other Programs Page 2 of 3
they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1)
mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410;
(2)
fax: (202) 690-7442; or
(3)
email:
[email protected].
This institution is an equal opportunity provider.
Free and Reduced Price School Meal Application Sharing Information with Other Programs Page 3 of 3