vienna · vienna . high school . 618-658-4461-telephone 618-658-8165-fax 601 north first street,...

Vienna High School District 13-3

-------------------------

Registration Packet

Vienna High School 618-658-4461-telephone 618-658-8165-fax601 North First Street, Vienna, Illinois 62995www.viennahighschool.com

AUTHORIZATION FOR SCHOOL RECORD RELEASE

In accordance with the Family Educational Rights and Privacy Act of 1974 the following

school records on ___________________________________, ____________ may be (grade level)

released:

1. _____ Personal (include copy of birth certificate and social security number)2. _____ Academic3. _____ Standardized Test Scores4. _____ Health Records5. _____ Disciplinary Reports6. _____ Psychological Evaluations; IEP; RTI Plan7. _____ Other (as specified; _________________________________)8. _____ Illinois Student Transfer Form (if Illinois student)

Last School Attended:

Name: _________________________________________________________________

Address: _______________________________________________________________

Phone: ______________________________ Fax: ______________________________

Authorized by: __________________________________________________________

Relationship to Student: _________________________________Date:______________

Please mail and fax records to: Vienna High School Guidance Office 601 North First Street Vienna, IL 62995 Fax: 618-658-2701

Vienna High School District 13-3 Emergency Information Grade_____ Male or Female Birthdate_______________ Birthplace_______________________

Student’s Full Name_______________________________________________________________________________

Soc. Sec. Number___________________________ Ethnicity_______________________

Mailing Address__________________________________________________________________________________

Physical Address__________________________________________________________________________________

Primary Phone Number_____________________________ Student’s Cell_____________________________

Parent’s email address ______________________________________________________________________________

This student lives with: (circle) Father Mother Stepparent Grandparent Other _______________

Father’s Name (Or Guardian) ____________________Address ____________________________________________

Birthdate__________ Cell #____________________Employer_______________________ Work #_______________

Mother’s Name (Or Guardian) ____________________ Address____________________________________________

Birthdate__________ Cell # ___________________Employer________________________ Work #_______________

I request that my child receive first aid service whenever it is deemed necessary. In case of an emergency, illness, or accident to the student above, the school is authorized to proceed as indicated below. I give permission for authorized school personnel to transport my child if we cannot be reached, and to seek other emergency care if our family physician cannot be reached.

List 3 emergency guardians who have agreed to take either temporary care (in case of illness) or extended care (in case of natural disaster) of your child if a parent cannot be reached. These listed also will be authorized to pick up your child if you are unavailable.

1. Name___________________ Phone # _________________________ Relationship ____________________________

Address__________________________________________________________________________________________

2. Name__________________ Phone # __________________________ Relationship____________________________

Address_________________________________________________________________________________________

3. Name ___________________ Phone # __________________________ Relationship ___________________________

Address_________________________________________________________________________________________

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Student Name _________________________________________________________________________________________

Family Physician___________________________________ Phone _____________________________________

Preferred Hospital __________________________________________ Phone ___________________________

Has the student ever attended public school in Illinois? Yes No

Known Medical Problems (Allergies, asthma, etc.) ___________________________________________________

Medications __________________________________________________________________________________

I authorize the school nurse to administer the following medications:

Ibuprofen Tylenol Antacids

If administered, I would like to be notified by; Call Letter Student to inform

Parent/Guardian Signature _____________________________________________ Date ____________________

AUTOMATED NOTIFICATION SYSTEM

(All-Call) This is our automated call system that alerts anyone listed for absences, school closures, and any announcements that go out on our all-call. If a student is absent and not called in by 8:30am, a call will go out at 9:00am to any number listed below, and again at 12:30pm if the absence has not been resolved by 12:00pm. Please list any phone numbers and email addresses you would like added to the VHS Notification System.

Phone Numbers

Name: ____________________ Number: _______________________

Name: ____________________ Number: _______________________

Name: ____________________ Number: _______________________

Name: ____________________ Number: _______________________

Name: ____________________ Number: _______________________

Email Addresses

Name: ____________________ Email: __________________________

Name: ____________________ Email: __________________________

Name: ____________________ Email: __________________________

Name: ____________________ Email: __________________________

Name: ____________________ Email: __________________________

___ / _ /

Male Female

which is located within the boundaries of Vienna High School District 13-3.

Do You: Own your own home Rent Other (explain) _____________________

Please read the following statements and initial each.

Name of Enrollment Personnel Student (please print)

Student Name: Date of Birth:

Name of Adult

You must provide documentation showing you live at the address listed above. Please attach a copy of three (3)

of the following documents. Please black out account and social security numbers on the documents.

Category B - Provide two (2) documents

Gas bill

Electric bill

Water/Sewer bill Food stamp card

Credit card statement

Pay check stub

City sticker receipt

Real estate tax bill

Signed lease

Mortgage document or payment book

Military housing letter

Section 8 letter

Name of Adult Enrolling Student (please print)

___________________________________________

Signature Date

_____________________________________________

___________________________________________

Signature Date

Verification of Residency and Enrollment

Street, City, State, Zip

I understand that knowingly or willfully providing false information to a school district regarding residency

of a child for the purpose of enabling that child to attend any school in that district without the payment of

nonresident tuition is a Class C misdemeanor.

I understand that knowingly enrolling or attempting to enroll a child in the school of a school district on a

tuition-free basis when I know the child to be a nonresident of the school district, unless the nonresident

child has a lawful right to attend, is a Class C misdemeanor and I will be liable for payment of tuition, fees,

and all other applicable fines.

___________________________________________

Driver's license/State ID

Grade:_______

I, _________________________________, live at___________________________, _____________, ________, _______,

Category A - Provide one (1) document

I affirm that the information presented in this verification form, in connection with any investigation of my

residency or the residency and custody of the student, is true, complete, and accurate.

Phone bill (not cell)

Cable bill

Vehicle registration

Bank Statement

Public aid card

Medicaid card

Vienna High School 618-658-4461-telephone 618-658-8165-fax601 North First Street, Vienna, Illinois 62995www.viennahighschool.com

Name:____________________________________________

Date:______________________

Do you have a parent that is active duty military? Yes No

Do you have a parent that is deployed overseas? Yes No

Will your parent be deployed within this school year? Yes No N/A

Home Language Survey

The state requires the district to collect a Home Language Survey for every new student. This information is used to count the students whose families speak a language other than English at home. It also helps to identify the students who need to be assessed for English language proficiency. Please answer the questions below and return this survey to your child’s school.

Student’s Name: ______________________________

1. Is a language other than English spoken in your home?Yes _____ No _____ What language? ________________________

2. Does your child speak a language other than English?Yes _____ No _____ What language? ________________________

If the answer to either question is yes, the law requires the school to assess your child’s Englishlanguage proficiency.

________________________________ _____________________________Parent/Legal Guardian Signature Date

_______________________________________________________________________ Espanol

Encuesta del Idioma en el Hogar El estado requiere que el distrito recoja información en una Encuesta del Idioma que se Habla en el Hogar (Home Language Survey o HLS por sus siglas en inglés) para cada estudiante nuevo. Esta información se usa para contar a los estudiantes cuyas familias hablan en el hogar un idioma que no es el inglés. También ayuda a identificar a los estudiantes que necesitan ser evaluados para la fluidez en el idioma inglés.

Por favor, conteste las preguntas a continuación y devuelva esta encuesta a la escuela de su niño.

Nombre del estudiante: ______________________________

1. ¿Se habla en su casa otro idioma que no es el inglés?Sí _____ No _____ ¿Cuál? ________________________

2. ¿Habla su niño(a) un idioma que no es el inglés?Sí _____ No _____ ¿Cuál? ________________________

Si la respuesta a cualquiera de las preguntas es “Sí”, la ley requiere que la escuela evalúe la fluidez de su niño en el idioma inglés.

_____________________________________ _____________________________ Firma del Padre/Madre/Encargado/Tutor Legal Fecha

ISBE 68-06 NSLP SBP (5/19)

Dear Parent/Guardian:

Children need healthy meals to learn. Vienna High School offers healthy meals every school day. Breakfast costs $1.80; lunch costs $2.80. Your children may qualify for free meals or for reduced price meals. Reduced price is $ 0.30 for breakfast and $ .40 for lunch. To apply for free or reduced-price meals, use the Household Eligibility Application, which is enclosed. We cannot approve an application that is not complete, so be sure to fill out all required information. Return the completed application to Charlotte Dixon.

Your child(ren) may qualify for free or reduced price meals if your household income falls at or below the limits on this chart.

Federal Income Eligibility Guidelines (Effective from July 1, 2019 to June 30, 2020)

Reduced-Price Meals (185% Federal Poverty Guidelines)

Household Size Annual Monthly Twice Per

Month Every Two

Weeks Weekly

1 23,107 1,926 963 889 445

2 31,284 2,607 1,304 1,204 602

3 39,461 3,289 1,645 1,518 759

4 47,638 3,970 1,985 1,833 917

5 55,815 4,652 2,326 2,147 1,074

6 63,992 5,333 2,667 2,462 1,231

7 72,169 6,015 3,008 2,776 1,388

8 80,346 6,696 3,348 3,091 1,546

For each additional family member, add 8,177 682 341 315 158

1. DO I NEED TO FILL OUT AN APPLICATION FOR EACH CHILD? No. Complete the application to apply for free or reduced price meals. Use one Household EligibilityApplication for all students in your household per district. We cannot approve an application that is not complete, so be sure to fill out all required information. Return thecompleted application to the school.

2. WHO CAN GET FREE MEALS? All children in households receiving benefits from Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for NeedyFamilies (TANF) and/or are foster children that are under the legal responsibility of a foster care agency or court are eligible for free meals regardless of your income. Also, yourchildren can get free meals if your household’s gross income is within the free limits on the Federal Income Eligibility Guidelines. Children who meet the definition of homeless,runaway, or migrant also qualify for free meals. If you haven’t been told your children will get free meals, please contact your school to see if your child(ren) qualifies.

3. WHO CAN GET REDUCED PRICE MEALS? Your children can get low cost meals if your household income is within the reduced price limits on the Federal Eligibility IncomeChart, shown above.

4. A MEMBER OF MY HOUSEHOLD RECEIVED SNAP OR TANF BENEFITS. THE SCHOOL SENT A LETTER STATING THAT MY CHILD IS AUTOMATICALLY APPROVEDFOR FREE MEALS BASED ON DIRECT CERTIFICATION. DO I NEED TO DO ANYTHING MORE TO ENSURE THAT MY CHILD RECIEVES FREE MEALS? No. You do notneed to do anything more to receive free meals for your child. If you have students not listed on the letter, contact the school immediately. If you do not wish to receive the freemeals, you should follow the steps outlined in the letter from the school to notify school personnel immediately.

5. 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 stayingtogether 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 leavetheir prior family or household? If you believe children in your household meet these descriptions and haven’t been told your children will get free meals, please contact yourschool.

6. MY CHILD’S APPLICATION WAS APPROVED LAST YEAR. DO I NEED TO FILL OUT ANOTHER ONE? Yes. Your child’s application is only good for that school year and forthe first few days of this school year. You must send in a new application unless the school told you that your child is eligible for the new school year.

7. I GET WIC. CAN MY CHILD(REN) GET FREE MEALS? Children in households participating in WIC may be eligible for free or reduced price meals. Please fill out the enclosedapplication.

8. WILL THE INFORMATION I GIVE BE CHECKED? Yes. We may also ask you to send written proof.

9. 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 becomesunemployed may become eligible for free and reduced price meals if the household income drops below the income limit.

10. 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 orwriting to the person listed above.

11. MAY I APPLY IF SOMEONE IN MY HOUSEHOLD IS NOT A U.S. CITIZEN? Yes. You or your child(ren) do not have to be U.S. citizens to qualify for free or reduced price meals.

12. WHO SHOULD I INCLUDE AS MEMBERS OF MY HOUSEHOLD? You must include all people living in your household, related or not (such as grandparents, other relatives,or friends) who share income and expenses. You must include yourself and all children living with you. If you live with other people who are economically independent (forexample, people who you do not support, who do not share income with you or your children, and who pay a pro-rated share of expenses), do not include them.

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 somework 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 overtimesometimes. 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 valueallowances 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 notinclude your housing allowance as income. Any additional combat pay resulting from deployment is also excluded from income.

16. MY FAMILY NEEDS MORE HELP. ARE THERE OTHER PROGRAMS WE MIGHT APPLY FOR? To find out how to apply for SNAP, TANF or other assistance benefits,contact your local Department of Human Services office or call (800) 843-6154 (voice) or (800) 447-6404 (TTY).

Sincerely,Charlotte Dixon

INSTRUCTIONS FOR APPLYING – COMPLETE ONE APPLICATION PER HOUSEHOLD PER SCHOOL DISTRICTIF YOUR HOUSEHOLD RECEIVES SNAP OR TANF BENEFITS, FOLLOW THESE INSTRUCTIONS AND RETURN THE COMPLETED FORM TO YOUR SCHOOL:

Part 1: List all household members, school and grade for each student, and a SNAP or TANF case number for any household member including adults receiving such benefits. (Attach another sheet of paper if necessary.) .

Part 2: Skip this part.


Part 4: Sign the form. (The last four digits of a Social Security Number are not necessary.)

Part 5 & 6: Contact Information, and Children’s Racial and Ethnic Identities: Answer these questions if you choose to. (Optional)

IF NO ONE IN YOUR HOUSEHOLD GETS SNAP OR TANF BENEFITS AND IF ANY CHILD IN YOUR HOUSEHOLD IS HOMELESS, A MIGRANT OR RUNAWAY OR HEAD START/EVEN START, FOLLOW THESE INSTRUCTION AND RETURN THE COMPLETE FORM TO YOUR SCHOOL:

Part 1: List all household members and the name of school for each child.

Part 2: If any child you are applying for is homeless, migrant, or a runaway check the appropriate box and call your school.

Part 3: Complete only if a child in your household isn’t eligible under Part 2. See instructions for All Other Households.

Part 4: Sign the form. Only if part 3 is completed, please include the last four digits of a Social Security Number. (or mark the box if s/he doesn’t have one).


IF YOU ARE APPLYING FOR A FOSTER CHILD, FOLLOW THESE INSTRUCTIONS AND RETURN THE COMPLETED FORM TO YOUR SCHOOL:

If all children in the household are foster children that are the legal responsibility of a foster care agency or court:

Part 1: List all foster children and the school name for each child. Check the “Foster Child” box for each foster child.



Part 4: Sign the form. The last four digits of a Social Security Number are not necessary.


If some of the children in the household are foster children that are the legal responsibility of a foster care agency or court:

Part 1: List all household members and the name of school for each child. Check the “Foster Child” box for each foster child.


Part 3: Follow these instructions to report total household income from this month or last month.

• Box 1–Name: List all household members with income.

• Box 2 –Gross Income and How Often It Was Received: For each household member, list each type of income received for the month. You must tell us how often the money is received—weekly, every other week, twice a month or monthly. For earnings, be sure to list the gross income, not the take-home pay. Gross income is the amount earned before taxes and other deductions. You should be able to find it on your pay stub or your boss can tell you. For other income, list the amount each person got for the month from welfare, child support, alimony, pensions, retirement, Social Security, Supplemental Security Income (SSI), Veteran’s benefits (VA benefits), and disability benefits. Under All Other Income, list Worker’s Compensation, unemployment or strike benefits, regular contributions from people who do not live in your household, and any other income. Do not include income from SNAP, FDPIR, WIC, Federal education benefits and foster payments received by the family from the placing agency. For ONLY the self-employed, under Earnings from Work, report income after expenses. This is for your business, farm, or rental property. If you are in the Military Privatized Housing Initiative or get combat pay, do not include these allowances as income.

Part 4: Adult household member must sign the form and list the last four digits of their Social Security Number (or mark the box if s/he doesn’t have one).


ALL OTHER HOUSEHOLDS INCLUDING MEDICAID AND WIC HOUSEHOLDS, FOLLOW THESE INSTRUCTIONS:

Part 1: List all household members and the name of school for each child.


Part 3: Follow these instructions to report total household income from this month or last month.

• Box 1–Name: List all household members with income.

• Box 2 –Gross Income and How Often It Was Received: For each household member, list each type of income received for the month. You must tell us how often the money is received—weekly, every other week, twice a month or monthly. For earnings, be sure to list the gross income, not the take-home pay. Gross income is the amount earned before taxes and other deductions. You should be able to find it on your pay stub or your boss can tell you. For other income, list the amount each person got for the month from welfare, child support, alimony, pensions, retirement, Social Security, Supplemental Security Income (SSI), Veteran’s benefits (VA benefits), and disability benefits. Under All Other Income, list Worker’s Compensation, unemployment or strike benefits, regular contributions from people who do not live in your household, and any other income. Do not include income from SNAP, FDPIR, WIC, Federal education benefits and foster payments received by the family from the placing agency. For ONLY the self-employed, under Earnings from Work, report income after expenses. This is for your business, farm, or rental property. Do not include income from SNAP, FDPIR, WIC or Federal education benefits. If you are in the Military Privatized Housing Initiative or get combat pay, do not include these allowances as income.

Part 4: Adult household member must sign the form and list the last four digits of their Social Security Number (or mark the box if s/he doesn’t have one).


Privacy Act Statement: This explains how we will use the information you give us. 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.

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 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] institution is an equal opportunity provider.

ISBE 68-03 NSSTAP Application Instructions (5/19)

2. Homeless, Migrant, Runaway, or Head Start (Categorically eligible) Homeless Migrant Runaway Head Start ______________________________________________________________________ __________________

Signature of Your School Homeless Liaison, Migrant Coordinator, or Head Start Director Date

3. Total Household Gross Income (before deductions) You must tell us how much and how often.

NAMES(LIST ALL HOUSEHOLD MEMBERS

WITH INCOME)

GROSS INCOME AND HOW OFTEN IT WAS RECEIVED (Example: $100/month; $100 /twice a month; $100/every other week; $100/week)

Earnings From Work (Before Deductions)

Welfare, Child Support, Alimony

Pensions, Retirement, Social Security

Worker’s Comp., Unemploy-ment, SSI, etc. (All other income)

Amount How often? Amount How often? Amount How often? Amount How often?

i. $ $ $ $

ii. $ $ $ $

iii. $ $ $ $

iv. $ $ $ $

v. $ $ $ $

4. Signature and Social Security Number (Adult must sign)An adult household member must sign the application. If Part 3 is completed, the adult signing the form must also list the last four digits of his or her social security number or mark the I do not have a social security number box.

__ __ __ - __ __ - __ __ __ __Social Security Number

I do not have a social security number.

I certify (promise) all information on this application is true and all income is reported. I understand the school will get Federal funds based on the information I give. I understand school officials may verify (check) the information. I understand if I purposely give false information, my children may lose meal benefits and I may be prosecuted.

______________________________ _____________________________________________________ _________________________________________________________ Date Printed Name of Adult Household Member Signature of Adult Household Member

5. Contact Information (Optional)________________________________________ ____________________________________________ ____________________________________________________________Work Telephone Number (Include Area Code) Home Telephone Number (Include Area Code) Home Address (Number, Street, City, State, Zip Code)

6. Children’s Racial and Ethnic Identities (Optional)Mark one ethnic identity: Hispanic/Latino Not Hispanic/Latino

Mark one or more racial identities: Asian Black or African American Native Hawaiian or Other Pacific Islander White American Indian or Alaska Native

– THE FOLLOWING SECTIONS ARE FOR SCHOOL USE ONLY –

INITIAL DETERMINATIONTOTAL INCOME $ ____________________ Per: Week

Every 2Weeks

Twice a Month Month Year

NUMBER IN HOUSEHOLD: ______

CHANGE IN STATUS:____________________________ Date ____________

LEAs must annualize income only when multiple incomes, at varying frequencies, are reported.Annual Income Conversion Weekly X 52 Every 2 Weeks X 26 Twice a Month X 24 Once a Month X 12

Free based on:homeless SNAP or TANFmigrant foster child runaway household’s income Head Start

Reduced based on: household’s income

Denied—Reason: income too high incomplete application

Non-qualifying SNAP/TANF

Signature of Determining Official _________________________________ Date: _________________________________

NAMES OF ALL HOUSEHOLD MEMBERS First, Middle Initial, Last School Name Grade

SNAP OR TANF CASE NUMBER ONLY Skip to Part 4 if you list a SNAP or TANF case number. At least one SNAP/TANF must be provided below. If you receive Medicaid and were not directly certified for free meals, you MUST apply based on household size and income.

* A foster child is the legal responsibility of a welfare agency or court.

APPLICATION FOR FREE MILK/MEAL AND REDUCED-PRICE MEALS—Complete One Application Per Household Per School District. Instructions on back. SCHOOL USE ONLY

1. All Household Members (Attach another sheet of paper if necessary.) Check if Error Prone Application

(for Student only)

A. B. C. D. E.

(for Student only)

Date Withdrawn: ________________________

Check if FosterChild*

x x x x x

68-03 School Year 2019-2020 NSSTAP (5/19)

2019-2020 Advisory 9:43-10:08

Lunch 11:46-12:22

Semester

Quarter 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th

Mitchell, K.Rottmann, H.Trovillion, N.

French, T.Gresk, P.Lindsay, C.Palmer, B.West, J.

Guest, R.Jones, B.Stearns, T.

Hill, D.Jones, B.Kerley, J.McKinney, B.

Adams, K.Hook, M.Kerley, J.McKinney, B. DRIVERSED DRIVERSED DRIVERSED DRIVERSED

Palmer, B.Palmer, M.

Mateyka, D.Palmer, M.

Bundren, E.

Johnson, A.Kerley, J.Rick, B.Smith, S.

Adams, K.Rottmann, H.

Ashby, L.Hight, K.Hunsaker, M.

Slife, R./ILCJATPSlife, R./Joppa

Prep Dual Credit/Advance Placement *Schedule Coding

Holding Based on SIC Course Numbering

Off-Site

Fine and Preforming Arts

Career and Technical Education

PE-CoEdSee Fine and Preforming Arts See Fine and Preforming Arts HLTEDUCA HLTEDUCA HLTEDUCA HLTEDUCA See Fine and Preforming Arts DRIVERSED Laboratory/Prep DRIVERSED Laboratory/Prep

See Science Prep PE-FITCONDI

Social Science and History

Physical, Health, and Safety Education

ENGI-PCP ENGI-PCR ENGI-PCRSPNI

SPNII SPNII SPNIII ESL ----------------------- ----------------------- ---------------------------------------------- -----------------------

Mathematics

Science

English and Language Arts

WRKEXPCA-JAG PrepCareer SpecialistCareer Specialist

LEADERSHIPENGIII-CR ENGII-PCP ENGIII-CR ENGII-PCP Prep ENGII-PCR ENGII-PCR

Prep ENGI-PCP ENGI-PCP See Social Science and History

Spring

ALGI

Fall Spring

ALGII ALGII Prep ALGII ALGII ALGI

Fall Spring Fall Spring Fall SpringFall Spring Fall Spring Fall

Vienna High School2019-2020 Master Class Schedule

Period 18:05-8:50

Period 28:54-9:39

Period 310:12-10:57

Period 411:01-11:46

Period 512:22-1:07

Period 61:11-1:56

Period 72:00-2:45

GEOMETRYPRECALC-MAT116/118 Prep CALC-MAT209 ALGIII-MAT041/043

GEOMETRYPRECALC-MAT116/118

ALGI ALGISee REACH ALGIII-MAT041/043

GEOMETRY Prep ALGI GEOMETRY

PHYSICSPrep PHYSCIENCE PHYSCIENCE PHYSCIENCE HORTPROMANAG BIOI BIOI

CHEMI CHEMII-AP ANAPHYS ANAPHYS CHEMI Prep

See Physical, Health, and SafetyBIOII BIOI BIOII Prep BIOII BIOII-BIO111 BIOI

See Physical, Health, and Safety UNIFIEDSCIEN UNIFIEDSCIEN See Physical, Health, and Safety See Physical, Health, and SafetySee Physical, Health, and SafetySee Career and Technical Ed

Bradley, L. ENGIV-ENG047/048 ENGIV-ENG111/112 ENGIV-ENG111/112Prep

ENGIII-ENG047/048 ENGIII-ENG047/048 ENGIV-ENG111/112

BASICAGSCI See Career and Technical Ed See Career and Technical Ed See Career and Technical Ed See Career and Technical Ed See Career and Technical Ed

----------------------- ----------------------- SPNI SPNI

Athletic Director

USHISSee Physical, Health, and Safety

USHISSee Physical, Health, and Safety See Physical, Health, and Safety

USHIS-HIS214/HIS108

See English Language Arts See English Language Arts See English Language Arts PSYCHOLOGY USWORLDAFF See English Language Arts See English Language Arts See English Language ArtsPrep WORLDGEOGRA WORLDGEOGRA Athletic Director WORLDGEOGRA WORLDGEOGRA

See Physical, Health, and Safety See Career and Technical EdUSGOV-GOV117

USGOV See Career and Technical Ed See Physical, Health, and Safety

PE-Boys

See REACH See REACH See REACH

See Career and Technical Ed

See REACH See REACH

See Physical, Health, and Safety Prep USHIS-HIS214/HIS108 USGOV-GOV117

See REACH PE-CoEd-----------------------

See Social Science and History PE-CoEd Prep PE-CoEdDRIVERSED Laboratory DRIVERSED Laboratory DRIVERSED Laboratory DRIVERSED Laboratory DRIVERSED Laboratory -----------------------

PE-CoEd

See Science See Social Science and History See Social Science and History See Social Science and History See Social Science and History See Social Science and History See Social Science and History

PUBPROYEARBO CREARTI/CREARTII/CREARTIII See Physical, Health, and Safety See Physical, Health, and Safety CREARTI/CREARTII/CREARTIII See Physical, Health, and Safety See Physical, Health, and SafetyPrep MUSAPPRE-MUS115/130 CHORUS MARCHBAND/INDTECHINSTRCypress Grade 8:15am-9:15am Buncombe Grade 9:30am-10:30am

PE-Girls PE-CoEd

Clayton, J.Prep ACCOUTI/ACCOUTII-BUS124 COMPSOFT COMPSOFT COMPSOFT COMPSOFT JOU-BUS128 CONECO-SEM200 CONECO-SEM200 COMMUNITECHN-BUS128

COMPMAINTEI/II COMPMAINTEI/II COMPMAINTEI/II COMPMAINTEI/II COMPMAINTEI/II COMPMAINTEI/II COMPMAINTEI/II

INTROTECHENGSee Social Science and History See Physical, Health, and Safety

ORIENHLTHOCC ORIENHLTHOCC Nurse

See Physical, Health, and Safety See Physical, Health, and Safety

NURSASST-CNA120 MEDTER-HIT100 Nurse Nurse Prep

See Social Science and History CONECO See Physical, Health, and SafetyCONEXTER-OSH101/102 CONINTER-OSH101/102 Prep

EDUCA-DIVSOC-EDU111/EDU110

INTROAGINDUSAGMETECH-WELD111*

AGLEADERSHIP AGLEADERSHIP AGLEADERSHIP

PARTSOC-SW121/COMHEALT-SW225 Social Worker Prep Social Worker Social Worker

Career Specialist WRKEXPCA-JAG WRKEXPCA-JAG

PERSONALDEVE Social Worker PERSONALDEVE Social Worker

WILLIFMAAGBUSMAN BASICAGMECH

DRAFT-DRA130*/133*/OSH101 INTROTECHENG ROBOTICS-OSH101 DIGGRAPHICS

West, J. See Science PrepNATRESCONSER

MATH/TUTORIAL MATH/TUTORIAL MATH/TUTORIAL SCIENCE/TUTORIAL Prep

See Physical, Health, and Safety

INTROAGINDUS

REACH

Special EducationSCIENCE/TUTORIAL MATH/TUTORIAL

REACHREACH REACH REACH REACH PrepSee Math See Math See Math See Math See Math TUTORIAL See Math

PrepLife Skills Life Skills Life Skills Life Skills Life Skills Life Skills Prep

ENGLISH/TUTORIAL ENGLISH/TUTORIAL ENGLISH/TUTORIAL ENGLISH/TUTORIAL ENGLISH/TUTORIAL ENGLISH/TUTORIAL

----------------------- ----------------------- -----------------------Construction Craft Preparation Program-Seniors (9:30am-11:30am Marion School Calendar)Construction Craft Preparation Program-Juniors (7:30am-9:30am Marion School Calendar)

KeyContent Area References Administration

DCT = Dual Credit Transferable, DCNR = Dual Credit Non-transferable Remedial, CR = College Ready, CP = College Preparatory, PCR = Pre-College Ready, PCP = Pre-College Preparatory

----------------------- ----------------------- ----------------------- ----------------------- AUTBODI-AUT130/II-AUT131

07302019-ViennaHS-Stafford

07242019-ViennaHS-Stafford

*Based on Shawnee CC’s course numbering. See SCC course catalog English sequence.

14th

Grade13th

Grade12th

Grade11th

Grade10th

Grade9th

Grade8th

Grade

Incoming Freshmen PSAT 8 Testing

English I-PCR

English I-PCP

PSAT 9 Testing

English II-PCP

PSAT 10/ACCUPLACER

Testing

English III-ENG047/048*

ACCUPLACERPSAT/NMSQT SAT

English IV-ENG047/048*

ACCUPLACERTesting

ENG047/048* ENG111/112*

ENG111/112* Transfer ENG/LIT

English IV-ENG111/112* Transfer ENG/LIT Transfer ENG/LIT

English III -PCRPSAT/NMSQT

SATEnglish IV-

ENG111/112* Transfer ENG/LIT Transfer ENG/LIT

EnglishVienna High School’s Course/Curriculum Alignment and Sequence Map

Vienna High School’s Course/Curriculum Alignment

and Sequence MapIt is one of Vienna High School’s primary goals to ensure that all students have the advantage of appropriate course placement to create an environment in which students can arrive at a

successful finish. The course/curriculum alignment and sequence map is one tool that

will be utilized to clearly communicate placement. As students move through each grade, assessment data will be captured to

ensure the best placement for that student’s individual skill level. This approach of proved

mastery based placement builds foundations as students move into pursuing future goals in

career and college readiness.

English Specific InformationAs students begin their freshmen year they will be placed into either English I-PCP (Pre-College Preparatory) or

English I-PCR (Pre-College Ready) course based on PSAT8 scores and teacher recommendation. Students will then move onto English II-PCP or English II-PCR base on their PSAT9 scores and/or teacher recommendation. After successful completion of English II the reading comprehension and sentence portions of the College Board’s ACCUPLACER assessment will be administered. The purpose of this assessment will be to determine college English readiness. Based on the scores of this assessment, students will either be placed into remedial non-

transfer college preparatory dual credit English III-ENG047/048 or non-dual credit college ready English III-PCR (with a possible exception granted by teacher recommendation). English III-ENG047/048 is considered a non-transferable prerequisite to college level transferable English. Students placed in non-dual credit English III will

be prepared to transition into dual credit English IV-ENG111/112 during their senior year. English IV-ENG111/112 is considered to be a transfer level college English course. Those students who obtain an English III-ENG047/048 placement their sophomore year will be post-tested on the reading comprehension and sentence portions of the College Board’s ACCUPLACER assessment or given consideration for completion of English III-ENG047/048 with a C or better. Based on the scores of this assessment or C or better completion, students will either be placed into remedial non-transfer dual credit college preparatory English IV-ENG047/048 or transfer dual credit college ready

English IV-ENG111/112.

www.viennahighschool.com

English II-PCR

07242019-ViennaHS-Staffordwww.viennahighschool.com

14th

Grade13th

Grade12th

Grade11th

Grade10th

Grade9th

Grade8th

Grade

Incoming Freshmen PSAT 8 Testing

Pre- Algebra(phased out as of

SY2020)PSAT 9 Testing Algebra I PSAT10 Geometry PSAT/NMSQT SAT Algebra II

ACCUPLACERTesting

MAT043 College Math I

College Math I College Math II

Algebra I PSAT 9 Testing Geometry PSAT10 Algebra IIACCUPLACER

PSAT/NMSQT SAT

Algebra III-MAT041/043* College Math I College Math II

Pre-Calculus-MAT116/118*

MAT209/MAT211*

MAT217*

Algebra I/Geometry

PSAT 9 Testing Algebra IIPSAT 10/

ACCUPLACER Testing

Algebra III-MAT041/043*

ACCUPLACERPSAT/NMSQT SAT

Pre-Calculus-MAT116/118*

MAT209/MAT211*

MAT217*

Pre-Calculus-MAT116/118* PSAT/NMSQT SAT Calculus-MAT209*

MAT211/MAT212*

MAT213*

MathematicsVienna High School’s Course/Curriculum Alignment and Sequence Map








Math Specific InformationAs students begin their freshmen year they will be placed into the appropriate math course based on the College

Board’s PSAT8 assessment coupled with teacher recommendation. Pre-Algebra will be phased out as of the SY2020. Once in a sequence students will follow it through to the end so that all content is covered. Students who have proven

academic strength and are interested in doing so will have the option of “doubling up.” For example, if a student demonstrates academic strength in Algebra I, he or she could request to take both Geometry and Algebra II in the same year, which would result in “jumping” sequence for the following year. All content is still covered allowing for the best foundation to be built. Once students have successfully completed Algebra II the Mathematics portion of the College Board’s ACCUPLACER assessment will be administered. The purpose of this assessment will be to determine college math readiness. Based on the scores of this assessment, students will either be placed into remedial non-transfer college preparatory dual credit Algebra III-MAT041/043 or Pre-Calculus-MAT116/118. Algebra III-MAT041/043 is

considered a non-transferable prerequisite to college-level transfer math. Pre-Calculus-MAT116/118 is considered to be a transferable elective prerequisite to the college-level calculus sequence. Those students obtaining an Algebra III-

MAT041/043 placement will be post-tested on the Mathematics portion of the College Board’s ACCUPLACER assessment or given consideration for completion of Algebra III-MAT041/043 with a C or better to determine whether they will be

placed back into an Algebra III-MAT041/043 course or be able to proceed with transfer-level math.

*Based on Shawnee CC’s course numbering. See SCC course catalog math sequence.

07242019-ViennaHS-Staffordwww.viennahighschool.com

ScienceVienna High School’s Course/Curriculum Alignment and Sequence Map








Science Specific InformationAs students begin their freshmen year they will be placed in Unified Science, Biology I, or Physical Science based on the

PSAT8 assessment coupled with teacher recommendation. Once in a sequence students will follow it through to the end so that all content is covered. Students who have proven academic strength and are interested in doing so will have the option of “doubling up.” For example, if a student demonstrates academic strength in Physical Science, he or she could

request to take both Biology I and Chemistry I in the same year, which would result in “jumping” sequence for the following year. All content is still covered allowing for the best foundation to be built. Science has been broken into four tracks that have been developed to fit the individual goals of each student. The General Science track serves to prepare

students for post high school career and vocational placement. The Life Science track serves students who have a career goal that would include, but not be limited to, the medical field and all related areas. The Physical Science track

serves students who are going into career fields with an emphasis in science, technology, math, or engineering. The Liberal Arts Science track serves those students who are college bound with career goals that will require minimal

science curriculum. Chemistry II is being taught in the conjunction with The College Board’s Advance Placement program as AP Chemistry (started in SY2020).

*Based on Shawnee CC’s course numbering. See SCC course catalog science sequence.

14th

Grade13th

Grade12th

Grade11th

Grade10th

Grade9th

Grade8th

Grade

Incoming Freshmen

General Science Unified PSAT 9 Testing Biology I PSAT10 Biology II/Ag Science/Hort PSAT/NMSQT SAT Ag Science/Hort

Life Science Biology I PSAT 9 Testing Physical PSAT10 Biology II-BIO111* PSAT/NMSQT SATAnatomy &

Physiology or Ag Science

none BIO 115/210/215/218*

Physical Science Physical PSAT 9 Testing Chemistry I PSAT10 Physics/Chemistry II-AP Chemistry PSAT/NMSQT SAT Physics/Chemistry II-

AP Chemistry none PHY 116/ CHE 114*

Liberal Arts Science Physical PSAT 9 Testing Biology I PSAT10 Chemistry I PSAT/NMSQT SAT Biology II or Physics none

SCHEDULE CHANGE REQUEST FORM

Student Name: ____________________________________

Grade: _____________________

List requested changes below:

Period Requested Change

1

2

3

4

5

6

7

Reason for change: ______________________________________________________________________________________________________________________________________________________________________________

Parent’s Signature: _________________________________________

Student’s Signature: ________________________________________

Date: _______________________________

GRADUATION CHECKLIST

_ __ 4 credits - English(!, II, III, IV)

4 credits - Physical Education

3 credits - Science (graduating class of 2007)

3 credits - Math (graduating class of2007)

1 credit- U.S. History

1 credit- Global Studies or World History

1/2 credit - Health Education

½ credit - Consumer Economics

½ credit - American Government

½ credit - Comp. Software/Keyboarding

½credit-Driver's Education

I credit- Music, Art, Foreign Lang., or Voe.Ed.

ELECTIVE CREDITS

*****REQUIREMENTS FOR VALEDICTORIAN AND SALUTATORIAN STATUS*****

Beginning with the class of 2012, the following credits will be required along with general VHS graduation requirements to be considered for valedictorian or salutatorian:

4 credits - English

4 credits - Science

4 credits - Mathematics

2.5 credits - Social Studies

PRESENT SCHEDULE

!.. _________________ _

2._ __ _ _ _______ _ _____

3. ---------------- --

4.____ _ _______ _ _____

5._______________ ___

6. ---------------- --

7.__________________

2 credits - Foreign Language

I credit - Vocational or Fine Arts

NEXT SCHOOL YEAR'S CLASSES

!. ________ __ _ _ _ ___ _

2 .. ________________ _

3 .. _________ _ _ _ _ ___ _

4.____________ _____

5. _______ __ _______ _

6. _ __ _ _ ___________ _

7. _ _______________ _

*****Prior Credits and Current Year Credits = Total Credits***** ----- ------- --------

Future Plans:---------------------------------------

On-Line Credit Rec. Class/es:

Summer/After School Class/es:

Yes

Yes

Counselor Signature/Date

No

No

Name of Class: ______________ _

Name of Class: ______________ _

Student Signature/Date

2013/04/23-ViennaHS-Stafford

Independent Study Program

Vienna High School

Description The Independent Study Program will offer junior and senior students the opportunity to take pre-approved, challenging, and rigorous course work through other institutions and be awarded credit at Vienna High School. Requirements/Guidelines

Student must be a junior or senior.

Student must be in good academic, disciplinary, and attendance standing.

Student must meet with administration for preapproval of all dual enrolment independent

study course work.

Student must have official grade report from host institution released to Vienna High School.

Student will be responsible for any cost associated with independent study course work.

Student will not be issued credit for courses that are available at Vienna High School.

Due to introductory nature of this program requirements and guidelines are subject to change.

Complete and return to the Guidance Office Student Name:

Course Name:

Host Institution:

Credits to be earned:

Estimated time to completion:

Cost:

Vienna High School Dual Credit/Escrow Information Sheet 2019-2020, 20190730

Associate of Arts/Associate of Science Degree Code: AA-0090/AS-0091 Minimum GPA: 2.0 Minimum Hours: 64

The Associate of Arts/Associate of Science degrees provide the first two years of general studies for baccalaureate degrees. Students should consult an advisor to tailor the transfer degrees to the desired Bachelor’s degree for a specific college/university. Courses within each section may expand to allow more options to the student. For an up-to-date listing of classes, please consult the Illinois Articulation Initiative website at www.itransfer.org. Communications (9 hours) Must earn at least a C in each course to graduate (Must either test out of or take ENG 0041/0047/0048) 3 ENG 111 – English Composition 3 ENG 112 – English Composition ___SPC 111 – Speech Fine Arts/ Humanities (AS: 6 hours AA: 9 hours) Must be taken from at least 2 categories Choose at least One Course ART 114 – Art Appreciation ___ART 117 – Art History Survey I ___ART 118 – Art History Survey II ___ ART 227 Afr Am Art & Artists 3 MUS 115 – Music Appreciation 3 MUS 130 – Intro to American Music ___SPC 124 – Theater Appreciation

Choose at least One Course 3 HIS 108 - Twentieth Century American History 3 LIT 210 – Intro to Literature ___LIT 211 – Intro to Poetry ___LIT 212 – Modern Fiction 3 LIT 213 – Intro to Drama ___LIT 214 – British Literature I ___LIT 215 – British Literature II ___LIT 216 – American Literature I ___LIT 217 – American Literature II

___LIT 218 – World Literature ___LIT 219 – Contemporary Multicultural Literature ___LIT 220 – Literature and Gender ___LIT 221 – African American Literature ___PHI 215 – Intro to Philosophy ___PHI 216 – Logic ___PHI 218 – Intro to Ethics and Values ___PHI 219 – Religion in American Society

Social Sciences (AS: 6 hours AA: 9 hours, taken from 2 different disciplines) ___ECO 211 – Economics - Macro ___ECO 212 – Economics - Micro 3 GOV 117 – American Government ___HIS 116 – Western Civilization to 1715 ___HIS 117 – Western Civilization from 1715 ___HIS 121 – World History Beginning - 1450 ___HIS 122 – World History from 1450 3 HIS 214 – History of US to 1877 **Bachelor’s degrees will need to have 9 hours of Fine Arts/Humanities and 9 hours of Social Science courses. The additional 3 hours of humanities and 3 hours of social science courses can be taken in addition to this degree or can be taken later at the senior university.

HIS 215 – History of US from 1877 ___HIS 217 – History of Eastern Civilization ___PSY 211 – Intro to Psychology ___PSY 216 – Social Psychology ___PSY 217 – Developmental Psychology: Lifespan ___PSY 218 – Child Psychology

___SOC 212 – Sociology ___SOC 217 – Marriage and Family ___SOC 218 – Cultural Diversity

Mathematics AS: 6 hours AA: 3 hours (Must test out of or take MAT 0039/0041/0043) ___MAT 110 – General Education Math ___MAT 112 – Math for Elem. Teachers II ___MAT 113 – Quantitative Literacy

___MAT 119 – Finite Mathematics 5 MAT 209 – Calculus I ___ MAT 210 – General Elem. Statistics

___MAT 211 – Calculus II ___MAT 212 – Calculus III ___MAT 215 – App Calculus for Bus & Social Science

Sciences AS: 3 courses with minimum of 10 hours AA: 7-8 hours, Must include at least 1 life and 1 physical at least one class must contain a lab Life Sciences 4 BIO 111 – Intro to Biology ___BIO 115 – Human Biology ___BIO 211 – Environmental Biology ___CHE 111-Inorg, Org, and BIO I

Physical Sciences ___AST 111 – Intro to Astronomy ___CHE 111 – Organic, Inorganic and Biochemistry ___CHE 114 – Inorganic Chemistry I ___GEO 213 – Geology ___GEO 215 – Intro to Environmental Geology ___GRY 214 – Intro to Physical Geography

___PHY 116 – College Physics I ___PHY 120 – Intro to Real World Physics ___PHY 216 – University Physics I

Electives (26-27 Hours): Must be chosen from the transfer courses listed in the back of the catalog and noted as a transferable course. Total Hours for the AS/AA degree must equal 64 hours. Developmental courses will not count as electives for any degree. MAT 115/116/118 may be necessary for some majors, however will not count in the general ed. core. Please consult an advisor prior to enrolling. Transferable 3 HIT 100 – Medical Terminology 4 MAT 116 – College Algebra 2 MAT 118- Trigonometry 3 SEM 200 – Career Decision Making 3 SW 121 – Introduction to Social Work 3 EDU 111 – Diversity of Schools/Society 3 EDU 110- Introduction to Education

Non-Transferable 6 CNA 120 – Certified Nurse Assistant 3 AUT 130 – Auto Body I 3 AUT 131 – Auto Body II ? *WEL 130 – Welding ? *WEL 133 – Welding 1 OSH 101 – Introduction to Workplace Safety 2 OSH 102 – OSHA 30 Hour General Industry 3 BUS124 – Bookkeeping 3 *DRA130 – Intro to Autocad 3 *DRA133 – 3-D Auto Cad 3 SW 225 – Community Health Systems 3 BUS 128 – Introduction to Management

Non-Transferable (College Preparatory) 3 ENG 047 – Basics of College Reading and Writing 3 ENG 048 – Fundamentals of College Writing 3 MAT 041 – Introduction to Algebra 5 MAT 043 – Intermediate Algebra

* Based on SIC Course Numbering

http://www.itransfer.org/

administrator

Typewritten Text

VIENNA HIGH SCHOOL

PHYSICAL EDUCATION WAIVER REQUEST

As a Vienna High School student, I would like to request a Physical Education waiver for the _ ________ _

school year for the following reason (please circle one): high school credit marching band college admission.

I understand I can only waive a maximum of 2 credits during my 4 years at Vienna High School ifl am a member of the

marching band. I also understand that Physical Education must be taken the year I take Driver's Education. The purpose

of the waiver is to allow me to take an additional academic class during this year because the class is needed for me to

graduate from high school, for admission to a college or university, or I am in marching band.

Student Signature

My schedule is as follows:

1.

2.

3.

4.

5.

6.

7.

As the parent or guardian of _________ _________ I consent for him/her to participate in the

P.E. waiver program in order to take an additional academic class.

Parent/Guardian Signature

Guidance Counselor Signature

Administrator Signature

administrator

Typewritten Text

administrator

Typewritten Text

administrator

Typewritten Text

Turn in at Station 8.

administrator

Typewritten Text

Student Name

Student's Birthday: / / Students Grade in School: 9 10 11 12

Previous high school(s) attended

Yes No

Yes No

Yes No

If yes , please provide a copy of the court order assigning custody.

The students lives full-time with:

Yes No Both parents

Yes No Mother who has legal custody

Yes No Father who has legal custody

Yes No Court appointed legal guardian

Yes No Other: If other please explain:

Factors pertinent to eligibility which are not stated previously:

1 2 3 4 5 6 7 8

Last Name

9th Grade 10th Grade 11 Grade 12 Grade

Number of semesters student has already attended high school for at

least 10 days:

IHSA Extra-Curricular Information for Students that Attended a Previous High School

Sports participated (practice or played) at previous school(s):

Did the student participate in a practice, try-out, or interscholastic contest in the current school year at the previous high school? If yes, list the sport(s):

Did the student and his/her parents, custodial parent, surviving parent, or court appointed legal guardian change residence from one public high school

district to a different high school district in conjunction with this transfer?

Did the student transfer in conjunction with a modification or other change in legal custody by action of a judge of a court of proper jurisdiction, with

custody being awarded to the parent with whom the student currently lives full-time within the district in which the receiving school so located?

1

2

3

4

First Name

38

Chapter 6 – Discipline and Conduct

Here you will find general student conduct requirements, student dress codes and cafeteria rules. Also included are new State mandated notifications on bullying and bullying prevention.

6.10 General Building Conduct

Students shall not arrive at school before 7:45 a.m. and classes begin at 8:05 a.m. and students are dismissed at 2:45 p.m. each day. The following rules shall apply, and failure to abide by the rules may result in discipline:

• Hats shall not be allowed in the building.• Students shall not run, talk loudly or yell in the hallways nor shall they push, shove or hit others.• Students shall not write on walls, desks or deface or destroy school property.• Skateboards are not permitted at school.• Water guns, play guns, and/or real guns are not permitted at school.• No radios, CD players, or cameras are permitted without permission from the principal.

6.20 School Dress Code/Student Appearance

Students are expected to wear clothing in a neat, clean, and well-fitting manner while on school property and/or in attendance at school sponsored activities. Students are to use discretion in their dress and are not permitted to wear apparel that causes a substantial disruption in the school environment.

• Student dress (including accessories) may not advertise, promote, or picture alcoholic beverages, illegaldrugs, drug paraphernalia, violent behavior, or other inappropriate images.

• Student dress (including accessories) may not display lewd, vulgar, obscene, or offensive language orsymbols, including gang symbols.

• Hoods from hooded apparel shall not be worn during the school day.• Coats, sun glasses, and colored contact lenses may not be worn in the building during the school day.

Coats, and sun glasses are to be kept in lockers during the school day.• Headbands may be worn if they are a solid color, no wider than 2 inches, and used for the purpose of

keeping hair out of the face. Bandana type headgear may only be worn if they meet this criteria.• Hair styles, dress, and accessories that pose a safety hazard are not permitted in the shop, laboratories, or

during physical education.• Clothing with holes, rips, and/or tears that appear above the mid-thigh may not be worn at school.• Clothing that is otherwise poorly fitting, showing skin and/or undergarments may not be worn at school.• Shirts must have sleeves and completely cover the back, abdomen (stomach) and cleavage.• The length of shorts or skirts must be appropriate for the school environment. No part of the bottom

hem of shorts, skirts and dresses should be above the mid-thigh (even with leggings). Mid-thigh representshalf way between the knee and top of the hip bone while standing.

• Appropriate footwear must be worn at all times.• If there is any doubt about dress and appearance, the building principal will make the final decision.• Student whose dress causes a substantial disruption of the orderly process of school functions or endangers

the health or safety of the student, other students, staff or others may be subject to discipline.

Students with questionable apparel issues will be sent to the nurse with a referral slip for a final determination. The nurse will inform the referring staff member and the student of her ruling. If the student is determined to be in violation of the policy, the referral slip will be forwarded to the principal and the disciplinary policy will be enforced.

For further details of the coverage outlined above, including costs, benefits, exclusions and any reductions or limitation, and the terms under which the policy may be continued in force, please refer to www.k12specialmarkets.com. Students are able to purchase coverage only if his/her school district is a policyholder with the insurance company.

Accidents aren’t supposed to happen, but they do.

School recess, one-day field trips and general day-to-day activities can all lead to injuries. Having coverage during school hours, or around the clock can insure your loved ones get the care they need without financial hardship to your family.

ELIGIBILITYAny enrolled student is eligible for coverage.

K-12 ACCIDENT PLANS THAT ARE AVAILABLETHROUGH YOUR SCHOOL:

• School Time Accident Only• 24-Hour Accident Only• Interscholastic Sports• 24-Hour Dental

All available plans are offered by Special Markets Insurance Consultants, Inc. To research which plans are being offered by your school, please visit our website’s online enrollment tool at www.k12specialmarkets.com

PAYMENTParents or guardians of students are responsible for enrollment and premium payment.

HOW TO ENROLL Enrolling is easy and only takes a few minutes.

Go to www.k12specialmarkets.com. 1. Click on Coverage Details at the top,2. Select State and click “Look Up”3. Click on School or District4. Click on link to display plan details.

Parents can either print and complete the enrolment application to mail with check or money order or:

You can enroll online: 1. Enroll online by clicking “Enroll Now”2. Select State and click “Look Up”3. Click on School or District4. Select school location name (if applicable)5. Check the plan options6. Complete online application (more than one

child can be enrolled on the same application)7. Pay by credit/debit8. Print ID card

FOR QUESTIONS, CALL 800.727.7642

vienna · vienna . high school . 618-658-4461-telephone 618-658-8165-fax 601 north first street,...

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