Student Registration Form Student Registration Form Documents for EnrollmentIn order to complete a new student registration parents must either bring the following documents to DeSmet school or attach the file if applicable. State Certified Birth Certificate Immunization Records Proof of Residency - (acceptable documents- current lease agreements, current property tax statements, current closing documents). Documents must have a name and address listed to verify residency. If you are a homeowner, a property tax statement can be printed at https://gis.missoulacounty.us/propertyinformation/ Please call the Desmet School Office with questions at 549-4994. Record RequestIs your student registering for EK Early Childhood Kindergarten?(Required) Yes No Is your student registering for Kindergarten?(Required) Yes No Is your student transferring from another school?(Required) Yes No School Transferring From(Required)Phone Number(Required)Fax Number(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Parent / Guardian Name(Required) First Last Student Name(Required) First Last Grade(Required)Pre-KindergartenKindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeEighth GradeStudent DOB(Required) MM slash DD slash YYYY Please attach the following information so that we may complete the student's enrollmentHealth / Immunization RecordsMax. file size: 75 MB. Attach file here or bring it to the schoolBirth Certificate Drop files here or Select files Max. file size: 75 MB. Attach file here or bring it to the schoolNote: Federal Law 99:37 specifies that parental signature is not required for educational records to be released to another educational agency. Thank you, Matthew Driessen Principal Enrollment FormDate(Required) MM slash DD slash YYYY Child Name(Required) First Name Middle Name Last Name Preferred Name Ethnic Group(Required) White/Non-Hispanic Native American/Alaska Native Black or African American Asian American Hispanic/Latino Native Hawaiian/Pacific Islander Required for state and federal reportsSelect All That Apply Father Mother Step-Father Step-Mother Guardian Father(Required) First Name Last Name Address (street address required for records) Mailing Address (if different than above street address) Home Phone Cell Phone Word Phone Place of WorkEmail Address(Required) Mother First Last Address (street address required for records) Mailing Address (if different than above street address) Home Phone Cell Phone Work Phone Place of WorkEmail Address Step-Father First Last Address (street address required for records) Mailing Address (if different than above street address) Home Phone Cell Phone Work Phone Place of WorkEmail Address Step-Mother First Last Address (street address required for records) Mailing Address (if different than above street address) Home Phone Cell Phone Work Phone Place of workEmail Address Guardian Name First Last Address (street address required for records) Mailing Address (if different than above street address) Home Phone Cell Phone Work Phone Place of workEmail Address Primary ResidencePrimary custodial Parent's name with whom the student lives with the majority of the time.Secondary Residence NamePlease list individuals in contact order in case of emergency. Include at least two neighbors or near by relatives who will assume temporary care of your child if you cannot be reached. 1.(Required) Name Relationship to Child Address Phone Number 2.(Required) Name Relationship to Child Address Phone Number 3. Name Relationship to Child Address Phone Number Health Concernsallergies, other conditions, remarksLocal Physician(Required) Name Address Phone Check the following that apply My child may participate in field trips My child may be published in school publications My child may be published in media publications My child and their work may be published on the school web site In case of an accident or serious illness the school will attempt to contact the parent/guardian. However, if necessary I hereby authorize the school to call the physician listed above I hereby authorize the school to call 911 or other appropriate medical assistance Other Siblings Attending DeSmet SchoolList the student's name and gradeStudent Transportation PlanThe following information is for every Monday, Tuesday, Wednesday, Thursday, and Friday. To find your student's bus check out our Bus Transportation Page.Is your student applying as a resident out of District #20?(Required) Yes No We do not provide transportation to out of District #20 areas. You will need to provide your own transportation to and from school. All nonresident students will be considered ineligible for school transportation services (20-10-101, MCA). This section does not prohibit out-of-district students from riding district buses provided they board the bus at established routes in the district).My student will have the same transportation schedule every day of the week.(Required) Yes No Weekly Transportation Schedule(Required) AM PM Monday(Required) AM PM Tuesday(Required) AM PM Wednessday(Required) AM PM Thursday(Required) AM PM Friday(Required) AM PM Special ServicesHas this student ever received any special services?(Required) Yes No Which special services has the student received?(Required) Special Education Speech or Language 504 Plan Title One Other Date of Service for Special Education(Required) MM slash DD slash YYYY Date of Service for Speech or Language(Required) MM slash DD slash YYYY Date of Service for 504 Plan(Required) MM slash DD slash YYYY Date of Service for Title One(Required) MM slash DD slash YYYY Describe the service your student received:(Required)Date of Service for Other(Required) MM slash DD slash YYYY Guidance on Race/Ethnicity Reporting FormMontana Office of Public Instruction (OPI)A change has been made to the reporting of race and ethnicity in educational data to better reflect the country's growing diversity. The change will take place in the 2010-2011 school year and will require all students to be identified using a new two-part race/ethnicity question. The federal government has established the two-part question to recognize Hispanic ethnicity and race as two separate and distinct concepts. Additionally, the change allows the reporting of multiple races (American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, White).Student Name(Required) First Middle Last DOB(Required) MM slash DD slash YYYY Grade(Required)Pre-KindergartenKindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeEighth GradeIdentify the ethnicity and race of the individual by answering BOTH questions.Is the individual Hispanic or Latino (choose only one)(Required) No, not Hispanic or Latino Yes, Hispanic or Latino Hispanic or Latino - A person of Mexican, Puerto Rican, Cuban, South or Central American, or other Spanish culture or origin, regardless of race.What is the individual's race? (Choose one or more races below)(Required) American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America, including Central America, and who maintains tribal affiliation or community attachment. Asian - A person having origins in any of the original peoples of the Far East Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, Vietnam, and Laos. Black or African American - A person having origins in any of the black racial groups of Africa. Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Note: Failure to answer both questions will result in use of prior racial/ethnic data or an observer identifying for youMT Office of Public InstructionHome Language SurveyStudent Name(Required) First Middle Last Birth Date(Required) MM slash DD slash YYYY Sex(Required)MaleFemaleParent/Guardian Name(Required) First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home PhoneWork PhoneEmail DistrictSchoolThis field is hidden when viewing the formGrade(Required)Pre-KindergartenKindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeEighth GradeToday's Date(Required) MM slash DD slash YYYY Is your child's first-learned or home language anything other than English? Yes No Does your child understand or communicate with anyone in the home using a language other than English? Yes No Does your child read and/or write in a language other than English? Yes No Does your child have exposure to a heritage or ancestral language other than English spoken by family, friends, or community members? Yes No If you answered YES to any question, what language(s) other than English does your child hear or use at home?If you answered YES to any questions, what language(s) other than English is your child exposed to in their home or community?If available, in what language would you prefer to receive communication from the school?This field is hidden when viewing the formWas your child born in the United States?(Required) Yes No This field is hidden when viewing the formWhich state was your child born in?(Required)This field is hidden when viewing the formWhat other country was your child born in?(Required)This field is hidden when viewing the formHas your child attended any school in the United States for any three years during their lifetime?(Required) Yes No This field is hidden when viewing the formPlease provide school name(s), state, and dates attended(Required)This field is hidden when viewing the formWhat language is spoken by you and your family most of the time at home?(Required)This field is hidden when viewing the formIf available, in what language would you prefer to receive communication from the school?(Required)This field is hidden when viewing the formPlease check if your child is Native American Indian Alaska Native Native Pacific Islander Virgin Islander This field is hidden when viewing the formIs your child's first-learned or home language anything other than English?(Required) Yes No This field is hidden when viewing the formWhat language did your child learn when they first began to talk?(Required)This field is hidden when viewing the formWhat language does your child most frequently speak at home?This field is hidden when viewing the formWhat language do you most frequently speak to your child?(Required)This field is hidden when viewing the formPlease describe the language understood by your child (check only one)(Required) Understands only the home language and no English Understands mostly the home language and some English Understands the home language and English equally Understands mostly English and some of the home language Understands only English Student Residency QuestionnaireThis questionnaire addresses the McKinney-Vento Act 2001. Your answers will help determine services available.Presently, where is the student living? Check one box.(Required) In a shelter (Joseph's Residence, YWCA Women's Shelter, Southgate Inn, Watson's Children's Shelter, etc.) Doubled up with another family in their house or apartment by necessity Doubled up with another family in their house or apartment by choice In a motel, car or campsite In Transitional Housing (McClay Commons, YWCA Transitional Housing) None of the above apply In the past 24 months, has your child attended(Required) No Schools 1 School 2-4 Schools More than 4 Schools Date Enrolled(Required) MM slash DD slash YYYY Grade(Required)Pre-KindergartenKindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeEighth GradeName of Student(Required) First Middle Last Female Male Birth date(Required) MM slash DD slash YYYY Name of Parent(s)/Guardian(s)(Required)1. Parent/Guardian Name 2. Parent/Guardian Name 3. Parent/Guardian Name etc...Current Address(Required) Street Address City State / Province / Region ZIP / Postal Code Phone/Message Number(Required)Alternate Phone/CellOver the Counter (OTC) MedicationsPlease fill this out to indicate which, if any, over the counter (OTC) medications we may dispense to your child. Please IRCL for a specific dosage amount, or we will determine dosage based on weight (taken in health office) and age. Please specify if you would like to be notified for medication being given, or to NOT dispense.If your child needs to take over the counter medications from home or prescription medication (this includes inhalers), there is a separate form you will need to fill out. For this form, or if you have any questions please call the school at 549-4994.Child's(Required) Name Age Grade Weight Parent or Guardians (printed) Best Phone Number during School Hours(Required)Medication Ibuprofen (Advil/Motrin - 200 mg tablets) Acetaminophen (Tylenol, extra strength - 500 mg tablets) Diphenhydramine (Benadryl - 25 mg capsules) Ibuprofen (Advil/ Motrin, Children's Liquid - 100 mg/tsp) Acetaminophen (Tylenol, Children's Liquid - 160 mg/tsp) Diphenhydramine (Benadryl, Children's Liquid - 12.5 mg/tsp) Antacid (Turns, Tablets) Bismatrol (Pepto-Bismol, Tablets) Cough Drops (Maximum 1 in morning 1 in afternoon) Please Check Box If School Can DispenseIbuprofen Dosage and Frequency(Required) 1 tablet every 4 hours as needed 2 tablets every 4 hours as needed Notify if Ibuprofen is Dispensed(Required) Yes No Acetaminphine Dosage and Frequency(Required) 1 tablet every 4 hours as needed 2 tablets every 4 hours as needed Notify if Acetaminophen is Dispensed(Required) Yes No Diphenhydramine Dosage and Frequency(Required) 1 tablet every 4 hours as needed 2 tablets every 4 hours as needed Notify if Diphenhydramine is Dispensed(Required) Yes No Ibuprofen (Liquid) Dosage and Frequency(Required) 1 tsp every 4 hours as needed 2 tsps every 4 hours as needed Notify if Ibuprofen (Liquid) is Dispensed(Required) Yes No Acetaminophen (Liquid) Dosage and Frequency(Required) 1 tsp every 4 hours as needed 2 tsps every 4 hours as needed Notify if Acetaminophen (Liquid) is Dispensed(Required) Yes No Diphenhydramine (Liquid) Dosage and Frequency(Required) 1 tsp every 4 hours as needed 2 tsps every 4 hours as needed Notify if Diphenhydramine (Liquid) is Dispensed(Required) Yes No Antacid Dosage and Frequency(Required) 1 tablet as needed 2 tablets every 4 hours as needed Notify if Antacid is Dispensed(Required) Yes No Bismatrol Dosage and Frequency(Required) 1 tablet as needed 2 tablets as needed Notify if Bismatrol is Dispensed(Required) Yes No Notify if Cough Drops are Dispensed(Required) Yes No Allergies/Medical Conditions (please explain)Vaccines Required for School AttendancePreschool - 12th GradePer MCA 20-5-402, a preschool is defined as a facility that provides, on a regular basis and as its primary purpose, educational instruction designed for children 5 years of age or younger and that: serves no child under 5 years of age for more than 3 hours a day. serves no child 5 years of age for more than 6 hours a day. Hib vaccine is not recommended for children older than 59 months. When following the ACIP schedule, children will have at least 5 doses of DTaP and 4 doses of polio vaccine. A pupil 7 years or older who has not completed the DTaP requirement must receive additional of Tdap vaccine or Td vaccine to become current in accordance with the Advisory Committee on Immunization Practice (ACIP) recommendations per ARM 37.114.705. While it is not recommended, if a child younger than 13 years receives their second dose of varicella at an interval of 4 weeks or longer, the dose does not need to be repeated. As of October 1st, 2015 pupils are required to have varicella vaccine and all pupils 7th-12th grade must have a Tdap vaccine. Note: A four-day grace period may apply, as appropriate, per the ACIP recommendations. September 2018Select Students Age Range(Required) 1-3 Years Old (Preschool) 4-12 Years Old (Grade/Middle School) 13+ Years Old (Middle/High School) 1-3 Years Old (Preschool) - Required Vaccines Haemophilus Inluenza Type B (Hib) -1 dose (given on or after the 1st birthday, unless child is older than 59 months) Diphtheria, Tetanus, and Pertussis (DTap, Tdap) - 4 doses Polio (IPV or OPV) - 3 doses Measles, Mumps, and Rubella (MMR) - 1 dose (dose must be given on or after 1st birthday) Varicella "chickenpox" (Var) - 1 dose (dose must be given on or after 1st birthday) 4-12 Years Old (Grade/Middle School) - Required Vaccines Diphtheria, Tetanus, and Pertussis (DTap, Tdap) - 4 doses (one dose must be given on or after the 4th birthday) Diphtheria, Tetanus, and Pertussis (DTap, Tdap) - 1 Dose of Tdap (prior to entering the 7th grade) Measles, Mumps, and Rubella (MMR) - 2 doses (first dose must be given on or after 1st birthday, and spacing between doses is 4 weeks) Varicella "chickenpox" - 2 doses (first dose must be given on or after 1st birthday, spacing between doses is 12 weeks for children under 13 years, and 4 weeks for those older than 13 years) 13+ Years Old (Middle/High School) - Required Vaccines Diphtheria, Tetanus, and Pertussis (DTap, Tdap) - 1 Dose of Tdap (prior to entering the 7th grade) Varicella "chickenpox" - 2 doses (first dose must be given on or after 1st birthday, spacing between doses is 12 weeks for children under 13 years, and 4 weeks for those older than 13 years) Library Permission FormAs your child begins the school year at DeSmet Elementary School, they will have the opportunity to borrow books from the school library. This involves a great deal of responsibility on the part of your child. It is our hope that you will reinforce this sense of responsibility in your child by encouraging them to properly care for and return the books in a timely manner. The number of books a child can borrow depends on their grade level. The loan time for books is one (1) week. Students must bring their book(s) to library in order to renew them. Books are renewed up to two (2) times unless another student has a hold on that title. This gives students up to three (3) weeks to finish their book(s). Kindergarten/First Grade — one book Second (2nd) Grade — two books Third (3rd) through Eighth OM — three books Overdue books will preclude a child from checking out any more books until the overdue item is returned. Lost books must be paid for before the student is able to check out any other items. If the book is lost and paid for, then found within that school year or the following school year, the student will be reimbursed. By reading with and to your children you enrich their educational experience here at DeSmet and further prepare them for future challenges. Please return the Library Permission Form on the following page. Your student cannot check books out until the form is on file with the school. Sincerely, DeSmet Elementary Librarian With your child, please review the library book permission form above. This form must be returned before books may be borrowed from the school library.Parental Consent I give my child permission to borrow books from the DeSmet School LibraryStudent's Consent(Required) I understand that should I lose or damage a library book, it will be my responsibility to work with my parent and the Librarian to replace or pay for the repair or replacement of the book.Parent's Consent(Required) I understand that should my child lose or damage a library book, it will be my child's and my responsibility to pay for the damage or replacement of the book.Universal Media Release FormDeSmet School District #20At times during and after the school day, school personnel and/or news media may ask to interview, photograph, audiotape, film and/or videotape students. This material may be utilized in media that includes, but is not limited to, the following: newspaper articles, television coverage, websites, internal or external publications, newsletters, video presentations, and/or school district presentations. Your signature on the form below authorizes the school district to release your child's name, photograph, and/or audio/video/film production for publication related to school functions and activities. Examples may include, but are not limited to, student activities, individual or group achievements, sporting events, musical or theatrical presentations, and/or discussion forums. Once signed and dated, this form shall remain in effect until the end of the current school year. At any time during the school year, however, you may revoke this permission for future use by notifying, in writing, the principal of the school.I give permission for the DeSmet School District to release my child's name, photograph, and/or audio/video/film reproduction for publication, broadcast or posting to the DeSmet School District website, as described above(Required) Yes No Title IAs you may know, Title I is a federally funded program for students who need additional support to meet the state's high academic standards. The goal of Title I is to identify students, give them assistance in the regular classroom when possible, provide interventions to enhance academic skills, and to increase student achievements so that students can be 100% successful in the classroom. DeSmet will administer a schoolwide Title I program. Under a schoolwide program, all students are eligible to receive academic support. DeSmet Public Schools utilize several educationally related formats to identify students who need additional academic support. These include, but are not limited to the SBAC Interim Assessments, DIBELS, teacher referrals, etc. We would like to point out that Title I is not designed to be a permanent identification or placement. My goal is to get students academically proficient as quickly as possible! Once we ensure that a student is proficient, we discontinue the support but continue to monitor their progress to make sure they stay on a successful academic track. Federal guidelines require that all schools receiving Title I funds to develop and distribute a School-Parent Compact (attached). The Compact is an agreement among participants working together for a common goal. Teachers, students, and parents all have a responsibility to continue to the effort to establish an effective climate for learning for all students. This Compact outlines the role of each group is an effort to provide a high quality education for our students. Please read through the attached Compact with your child, sign, and return the form to your student's teacher. Thank you for being an active participant in your child's education! If you have any questions, please feel free to contact me. I am more than happy to answer all questions or concerns that you may have. Sincerely, Carly Aho Carly Aho Title I Specialist caho@desmetschool.com We all have a role to play in the success of children. At DeSmet Public school you are valued as a parent and co-educator in the assistance of high academic achievements for your child. While at DeSmet Public School your child will participate in programs, academic activities and service funded by A School Wide Model of Title 1 as part of the Elementary and Secondary Education act (ESSA). In partnership, we will strive to help all succeed in achievement of our rigorous Montana Educational Standards. This compact is written as a reference of the responsibilities we all share. It is in effect during the 2021-2022 school year. School's Responsibility: Provide high-quality curriculum and instruction Ensure a safe, productive learning environment Provide Parents or Guardians reasonable access to the staff (emails, phone calls, scheduled meetings) Provide ongoing communication between school and home: newsletters and notes, flyers or posts on the DeSmet Website parent/teacher conferences reports about child's progress opportunities to volunteer in school and classrooms or to observe and participate in classroom activities Parent's Responsibility: Ensure that my child attends school daily and arrives on time Encourage my child to show positive school behaviors Assist with school work completion and ensure that daily home reading occurs Attend parent/teacher conferences, scheduled meetings and school activities that include my child Limit screen times (TV, movies, phone, electronic games) and monitor and encourage positive extracurricular activities Provide age appropriate sleep routines (see below) and healthy nutritional choices Student's Responsibility: Attend school daily and on time Complete all assignments on time and try my best to learn Read at home daily (including being read to!) Resolve conflicts peacefully and accept responsibility of my actions Show respect for myself, other people and property School, Parents and Student Responsibility: Have high expectations Build and develop working relationships Communicate, ask questions Please review this compact with all family members. Feel free to discuss the content with your child's teacher or appropriate staff member. Thank you for your involvement. Matthew Driessen Carly Aho I have read the above information.(Required) This is a mandatory part of your child's official school records.Yellowstone Boys and Girls RanchSBS Information for ParentsSchool Based Services (SBS) are mental health services delivered by a licensed mental health center in partnership with a public school. It includes having two mental health staff, one master's level (therapist) and one bachelor's level (behavior specialist) working with an average caseload of 12-18 students in up to two schools. What does that mean for you as a parent/guardian? Yellowstone Boys and Girls Ranch (YBGR) and the school your child attends have agreed to house a therapist and behavior specialist at the school. The therapist will work with your child's teacher to schedule times to meet your child for individual and group therapy. The therapist and behavior specialist will work with you to schedule time for family therapy. The behavior specialist will work with teachers to schedule time in the classroom, recess, lunch etc. to provide behavior intervention to your child as needed. The therapist is similar to a school counselor or school psychologist. However, the issues addressed by the therapist can often be more in depth than the school counselor and more intensive than a school psychologist. Also, the caseload for the SBS staff is approximately 12-18 kids, instead of dozens/hundreds The behavior specialist works with teachers to identify areas where your child needs more support. Perhaps, your child struggles during reading or math. The teacher may recognize that if this student has additional structure your child wil be successful. Your child may struggle at recess or during lunch, the SBS staff can work this time into their schedule and offer support during these unstructured times, such as modeling and teaching coping skills to kids. Behavior Specialists are not tutors nor may they offer educational assistance to your child. Their role is to provide emotional and behavioral guidance and structure. Therapists can also provide this guidance. What are the benefits of having SBS staff work with your child? The therapist and behavior specialist individualize a program that meets the needs of your child. They provide additional therapeutic support to your child by identifying areas of concern and developing a program that addresses these areas based on the needs of your child. These two staff provide a comprehensive overview of what is going on in the home, school, and community that may be affecting the child. The SBS staff can then work with teachers, parents, and professionals to provide comprehensive school and community treatment. What do SBS teams need from parents/guardians? SBS staff need INVOLVEMENT and PARTICIPATION from the parents/guardians. You know your child better than anyone. The SBS staff need your participation in the child's treatment to work towards a successful outcome. Participation from caregivers increases the success of kids in an SBS program. SBS staff need a TEAMWORK approach. As mental health workers, SBS staff are required to complete quarterly treatment plans for each identified child. They wil be asking for your input and need your willingness to offer support. In addition, they will need you to cooperate with a yearly clinical assessment and signing of releases of information every 6 months. This relationship is reciprocal. A parent's input is valuable and necessary during treatment. SBS staff are willing to give feedback and help in brainstorming ideas on how to best address the child's needs. How does a child qualify for SBS? There are two qualifying factors for SBS: meeting mental health criteria and funding. SBS staff are trained to determine these two factors. SBS staff work with parents and guardians to determine eligibility. Students and parents/guardians wil participate in a mental health assessment with the therapist to determine qualification for the program. Students do not have to be identified as meeting the requirements for Special Education services to receive SBS. Students on Medicaid are eligible for SBS services. In addition, our staff follows up on any insurance benefits that may be available to pay for SBS. SBS staff also offers a sliding fee scale to parents/guardians who may be interested in services but do not have Medicaid or private insurance benefits and cannot pay out of pocket for services. Do schools pay for SBS staff to be on school campuses? Schools do not pay a direct cost for SBS staff to be in your school. However, there are in-direct costs such as space, office supplies, internet and telephones that are provided by school districts. What are the goals for the partnership between the school, parents, and YBGR? The primary goal is to help high-risk students be successful behaviorally, socially, emotionaly, and academically. This program si an intervention to provide preventative services to youth and maintain them in their current home/school/community setting. How do parents access crisis assistance for a SBS client? The SBS staff are available during school hours to parents)/guardian(s) for crisis assistance. They can be contacted at the school or via cell phone. During evenings, weekends, or other non-school days, the child and/or parent(s)/guardian(s) may contact the YBGR-CBS Emergency On-call phone number - 406-647-3805 for emergency crisis assistance. For more information contact your site SBS team or our admission department at cbs-vip@ybgr.org or 406-606-4060. Additional information about mental illness is available on our website at www.ybgr.org Contact DeSmet's SBS team at: Elisa Meier, Program Therapist emeier@desmetschool.org (406) 876-4124 This field is hidden when viewing the formWould you like to learn more about Altacare CSCT Services?(Required) Yes No Who does my child receive Altacare services from? Altacare staff consists of a licensed Therapist and a Behavioral Specialist. Altacare staff are a part of a multidisciplinary team consisting of the child's guardian/parent, a school administrator (or designee), and a mental health therapist, at a minimum. The therapist working with the child will develop a treatment plan to meet the therapeutic needs of the child.What will my child be learning? Altacare provides opportunities to learn: Positive peer interactions Appropriate coping skills Anger management techniques Positive self-image Behavior modification Virtues education "What lies behind us and what lies before us are small matters compared to what lies within us." - Ralph Waldo EmersonWill my child benefit from CSCT services? A few behavioral indications a child may benefit from therapy include: Low self-esteem Excessive anger, worry, sadness, or fear Immature behavior for the child's age Behavior that interferes with the ability to make friends Problems eating, sleeping or eliminating Preoccupation with sexual behavior Physical symptoms with unknown medical causes (headaches, stomachs etc) Difficulty adjusting to family changes Talking about not wanting to live Excessive shynessAdmission to Altacare To receive Altacare CSCT therapeutic services a child must have: Parent/guardian consent to service Clinical appropriateness determined A funding source (current HMK, private insurance, or private pay with sliding fee) *A child can be referred to Altacare by school administration, teachers, medical or community services or at the family's requestServices Provided by Altacare Individual Therapy Group Therapy Family Therapy Social Skills/ Anger Management Recreational Therapy Case Management Crisis Support Summer ProgrammingAdditional Services Available Behavioral support in school setting Psychiatric Consultation Referral to Additional Community ResourcesPayment Options Payment sources accepted by Altacare as follows: Medicaid Private insurance Self-pay with sliding fee scaleDeSmet School WebsiteInstructions for Parents: After your student(s) is registered and you have given the school a current email address, an email will be sent to you. It will explain what you need to do to get registered for the parent portal. The URL link that is sent in your email will give you 2 days to register. After the 2 days your link will expire. This portal will allow you access to your student's information such as attendance, grades, missing assignments and more. You will also need to check all boxes as to home you would like to receive notifications from the school. For example, you would be able to get notifications on important issues such as: buses are running late due to road condition, no school due to weather or your student has been marked absent, etc.Instructions for Students: Student may register at home or at the school. To register the student will need to get on the DeSmet school website at www.desmetschool.org and click on the Infinite Campus Link. User name: first letter of their first name and full last name. For example: John Doe would be jdoe (If you have 2 students with the same first letter of first name, you will need to also put first letter of the middle name. For example: Sister of John Doe, Jane Marie Doe would be jmdoe) Password: desmetschool Student will be forced to change password as soon as they log on. If you have any questions please call the school office at 549-4994Name(Required) First Last Phone #(Required)Email(Required) Child's(Required) Name Grade I may not be able to make all meetings, but please contact me for special events.I can help by: Add RemoveEx. Baking, sign making, booth/table monitor, crafting, etc. We appreciate any help you can offer!DeSmet School District #20An out of District Guide for ParentsThe District considers the following criteria for discretionary admission of nonresident students: the student's academic record, disciplinary record, including truancy records, and the current student level in the class in which the student would be admitted. The District will not admit any student prior to viewing that student's records from the student's previous school districts. In the case of incoming kindergarten students or those who have been home-schooled, cases where no prior records exist, the Superintendent, or designee will meet with the family and determine the student's likelihood for success based on behavior, attendance and acceptance of school expectations and policies. The Superintendent or designee will review the student candidate based on the above listed criteria while also considering current sibling enrollment and if a dependent of a current or incoming employee to determine whether or not to recommend the student for admission. In the case of too many requests for a special grade level, students will be selected using a lottery system after the previous criteria have been applied. The District will not admit any nonresident student who is serving a suspension or expulsion in another school district. Every Student who attends the District as a nonresident student is subject to reevaluation every year and will be assessed annually. Administration will assess all nonresident students at the end of each year. The Board may declare an emergency which, in its opinion, necessitates the removal of all nonresident students from the schools. The Board will not admit any student who is expelled from another school district. All resident students who become nonresident students due to a move by the students' parents from the District may continue attendance for the semester, barring registration in another school district. At the completion of the semester, the student must apply for admission as a nonresident student if the student wishes to remain in the District. We do not provide transportation. You will need to provide your own transportation to and from school. All nonresident students will be considered ineligible for school transportation services (20-10-101, MCA). This section does not prohibit out-of-district students from riding district buses provided they bored the bus at established routes in the district).Student Name(Required) First Last Grade Entering(Required) Pre-Kindergarten Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade Last School Attended(Required)Last School Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Last School Phone #(Required)Parent/Guardian Name(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)School District you currently live in(Required)Email(Required) Please provide a cover letter stating the reasons you want your child/children to attend the DeSmet school District.(Required) Drop files here or Select files Max. file size: 75 MB. Please provide proof of the following criteria (attach any appropriate documentation from previous school): Student can provide a previous record free of truancy. Student can demonstrate a clean behavior record in the school last attended for a period of at least one year. Student has passing grades in school previously attended. Student presents no other educationally related detriment to the students of the district.By submitting this form, the parent/guardian understands and accepts the following stipulations: Admission to the DeSmet School District is a privilege and not a right granted by law(20-5-320) MCA. If accepted, the student is subject to a one-year probation period and could be removed from the school any time during this probationary period. The DeSmet School District will not admit a non-resident student when to do so would require the hiring of additional staff, the provision of educational services not currently provided in the school, or the crowding of existing classes. The Board of Trustees may declare an emergency which, in their opinion, necessitates the removal of all non-resident students from the school. To be considered for attendance, the student may not have a criminal record. The parent/guardian hereby gives consent for the school district to call appropriate law inforcement officials for verification. Final acceptance will be determined ones all appropriate records have been forwarded to the DeSmet School District, i.e., cumulative folder, immunization records, etc.SignatureYour signature and submission of this form signifies that you are the legal guardian of this child and all information on this form is true to the best of your Knowledge.Parent / Guardian Signature:(Required)Date:(Required) MM slash DD slash YYYY