Alva High School Student Forms
2016-2017
Student’s Name _______________________ Grade _________
Consent and Release
Directory Consent
Drug Free
Home Language
Internet Usage Application
Locker Contract
Parental Authorization to Administer Medication
School Bus Rules
Self Administration of Asthma Medication Form
Title VII Eligibility
All forms MUST be filled out and returned to the
high school office as soon as possible.
Please see the laptop computer contract and
insurance form beginning on page 20. This MUST
be returned to the office before a laptop computer
will be checked out to the student.
It is the policy of the Alva Independent School District #001 to provide equal opportunities
without regard to race, color, national origin, sex, age qualified handicap or veteran status.
If you feel this policy was not me, please contact the Alva Independent School District
Compliance Officer at 580-327-3682.
Ella es la política de la 001 # de distrito escolar independiente Alva paraproporcionar pie
de igualdad oportunidades sin respecto a la raza, color, origen nacional, sexo, edad
calificados Estado de la minusvalía o veterano. Si piensa que esta política no se cumplió,
por favor en contacto con el oficial de Compliance de distrito escolar independiente de
Alva en el 580-327-3682.
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Alva ISD #001 Drug Free School and Campuses Policy
JICH
(Exhibit)
PARENTAL FORM
FOR STUDENTS GRADE 6 THROUGH 12
Note to parent: Federal Law requires that school districts distribute the adopted drug
prevention policy to all parents and students enrolled in school. Parents are requested to read
the “Drug-Free” School and Campuses Policy” found on pages 54 and 55 of the student
handbook. This form must be signed and returned to the child’s school acknowledging that the
parent has been informed of the district’s drug policy.
Having read Alva Independent School District’s “Drug-Free School and Campuses Policy,”
I,
______________________________________________________________________________
Parent of______________________________________________________________________
grade _____________, understand the consequences and possible disciplinary actions for a
student due to unlawful possession, use, distribution or being under the influence of illicit
drugs, low point beer and alcohol on school property or as a party of any school activity.
STUDENT FORM
I have been informed of the Alva Independent School District’s “Drug-Free School and
Campuses Policy” and I understand the consequences and the resulting disciplinary actions due
to the unlawful possession, use and distribution or being under the influence of illicit drugs, low
point beer and alcohol on school property or as a party of any school.
_______________________________
Student’s Signature
_______________________________
School
_______________________________
Date
District #001, Woods County , Oklahoma
05/06/02
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See Computer and Internet Usage Contract Pages 61-65 of Alva High School Student Handbook
Computer and Internet User Application
Alva Independent School District
User’s Full Name (Please Print):____________________________
Home Address:__________________________________________
Home Phone:____________________________________________
I am a(n)
_____
_____
_____
_____
Administrator
Teacher
Staff
Alva Public School student. I will graduate: __/__/___
I understand and will abide by the Terms and Conditions contained in this contract. I further
understand that any violation of the regulations is unethical and may constitute a criminal
offense. Should I commit any violation, my access privileges may be revoked, school
disciplinary and/or appropriate legal action may be taken.
User Signature_____________________________ Date: ___/____/___
Parent/Guardian
(If user is under the age of 18, a parent or legal guardian must also read and sign this
agreement.)
As Parent or legal guardian of this student, I have read the Terms and Conditions for Alva
Independent School District #001 computer and Internet access and usage. I understand
that this access is designed for educational purposes and that The Alva Independent School
District has taken all available precautions to eliminate controversial material; however, I
also recognize it is impossible to monitor and restrict access to 100% of every type of
controversial material available on the Internet. I will not hold The Alva Independent School
District responsible for materials acquired on the Internet or through the Alva ISD #001
Intranet.
I hereby give my permission for my child to utilize the provided Internet and Intranet and
shall hold harmless Alva ISD for any inappropriate material acquired through such use. I
certify the information on this user application is correct.
Parent or Guardian (Please Print) _______________________________________
Signature:________________________________________ Date ____/____/____
School Copy (Sign and return to School)
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LOCKER CONTRACT
Name______________________________
I hereby acknowledge that I have been assigned a locker by the school
administration for my convenience. My designated locker is identified as locker
number _________________.
I understand as follows:
1. The locker provided to me at all times remains the property of the school
district.
2. I do not have any reasonable expectation of privacy towards school
administrators or teachers in the contents of this school locker or other
school property assigned to me.
3. I hereby acknowledge that school personnel shall have access to school
lockers, desks, and other school property in order to properly supervise
the welfare of all students.
4. For security purposes I am NOT to change lockers.
5. It is not safe to leave money or other valuables in an unlocked locker as
theft may be a result.
6. I may only put a lock on the locker assigned to me if I give a copy of the key or
combination to the principal’s office.
Date:______________________, 20_______.
Student’s Signature________________________________________
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ALVA INDEPENDENT SCHOOL
HIGH SCHOOL 1<-->1
TECHNOLOGY BASED 21st CENTURY LEARNING ENVIRONMENT
The Board of Education, the Administration and Staff at Alva Independent School are
committed to providing the students of Alva Independent School the best educational tools
available within the affordable limitations of the district.
In order for students to function in the 21st Century work environment, they must be able
to compete in the global market which utilizes modern technologies and web based
resources. That is why we, as a school district, are committed to a web-based curriculum,
and a technology based learning environment for our students.
Students in grades 9 – 12 will be provided a student laptop, carrying case and power
supply as though it were a textbook. Curriculum and instruction will be provided by the
teacher in a format adapted to the laptop. Pod casting, blogging, e-mail, video
production, and other proven applications will be used by students and teachers in their
learning environment. Collaboration and group projects will also be an integral part of
the learning experience. Students are responsible for the use and care of the computer
and replacement cost of $1000.00.
Students receiving a laptop, will retain use of the same laptop throughout the duration of
their educational experience at Alva (unless rights are lost due to inappropriate use, or
discipline). All students (grades 9 – 12) will be issued a laptop near the beginning of
school.
Insurance options will be made available.
As you are aware, to function in this type learning environment, requires different rules
and regulations. We expect our students to “Do what’s right”, and the large majority of
them do. The following criteria is of utmost importance not only for the students
protection, but for the protection of the school district. It also applies a higher level of
responsibility to the student, not only for their learning, but for the care of their assigned
computer.
Student learning potential is unlimited, with 24/7 access to information, and the
acquisition of knowledge.
For those who refuse to follow the guidelines set forth below, there are discipline
consequences that follow.
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LAPTOP USE REQUIREMENTS
Students will:
 have constant knowledge of the where-abouts of their computer

charge their laptop daily

always carry laptop in case provided

only use laptop in ways that are appropriate

be prepared to have laptop or bag inspected at any time

follow all rules governing use of computer and internet access

be responsible for damage or loss caused by neglect or abuse

report lost or stolen laptop immediately (stolen – must file police report)

pay for case &/or power supply in the event they are damaged or stolen

not loan their laptop to another student

not share their user name and password with other students

not allow food or drink within close proximity of their computer

not disassemble any part of their laptop (voids warranty and insurance)

not place any marks, stickers, decorations, etc on laptop or bag

not delete, copy or modify files belonging to others w/o prior consent

not vandalize or damage other computers
INTERNET USE REQUIREMENTS
Students will:
be given flexibility in the use of the internet unless they violate their rights and/or
the internet code of conduct
practice network etiquette at all times
will not reveal personal data (home, address, phone numbers, or numbers of
others
will be allowed use of head phones as directed by instuctors or administrators
will be allowed to download music for projects (inappropriate music will result in
discipline)
not be allowed to download software to the laptop w/o Tech Director approval
not be involved in inappropriate use of e-mail
not delete any folders or files that you did not create or that you do not recognize.
(deletion of certain files will jeopardize the operation of the computer)
not play or download games on the laptop
not violate copyright laws (including installation of copyrighted software)
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not create, access or process offensive or pornographic messages, pictures; use
obscene or threatening language; harassing, hate related or discriminatory
remarks.
Policy violations may result in the following disciplinary action:
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Removal of laptop use
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Mandatory Parent Conference
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Behavior Contract &/or loss of computer rights
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In-school suspension
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Suspension
6.
Notification of outside authority/police (charges filed if appropriate)
7.
Administrators discretion
(NOTE: Students who leave the district must return the computer to the district
before leaving. Laptops not returned will be reported to the Police as
Stolen and charges will be filed. Use of the Laptop is a privilege, not a right.
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STUDENT GUIDELINES FOR ACCEPTABLE USE OF TECHNOLOGY RESOURCES
These guidelines are provided here so that students and parents are aware of the
responsibilities student accept when they use Alva Independent School District owned
computer hardware, operating system software, application software, stored text, data files,
electronic mail, local databases, CD-ROMs, digitized information, communication
technologies, and Internet access. In general, this requires efficient, ethical, and legal
utilization of all technology resources.
1. Expectations
a. Students are allowed use of computers, other technology hardware, software, and
computer networks, including the Internet, only when supervised or granted
permission by a staff member.
b. All users are expected to follow existing copyright laws. Copyright guidelines
are posted and/or available in the media center of each campus as well as posted
on the District website.
c. Although the District has an Internet safety plan in place, students are expected to
notify a staff member whenever they come across information or messages that
are inappropriate, dangerous, threatening, or make them feel uncomfortable.
d. Students who identify or know about a security problem are expected to convey
the details to their teacher without discussing it with other students.
2. Unacceptable conduct includes, but is not limited to the following:
a. Using the network for illegal activities, including copyright, license, or contract
violations or downloading inappropriate materials, viruses, and/or software, such
as but not limited to hacking and host file sharing software.
b. Using the network for financial or commercial gain, advertising, or political
lobbying.
c. Accessing or exploring on-line locations or materials that do not support the
curriculum and/or are inappropriate for school assignments, such as but not
limited to pornographic sites.
d. Vandalizing and/or tampering with equipment, programs, files, software, system
performance, or other components of the network.
e. Use or possession of hacking software is strictly prohibited.
f. Causing congestion on the network or interfering with the work of others, i.e.,
chain letters or broadcast messages to lists or individuals.
g. Intentionally wasting finite resources, i.e., on-line time, real-time music.
h. Gaining unauthorized access anywhere on the network.
i. Revealing the home address or phone number of one's self or another person.
j. Invading the privacy of other individuals.
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k. Using another user's account, password, or ID or allowing another user to access
your account, password, or ID.
l. Coaching, helping, observing, or joining any unauthorized activity on the
network.
m. Forwarding/distributing e-mail messages without permission from the author.
n. Posting anonymous messages or unlawful information on the system.
o. Engaging in sexual harassment or using objectionable language in public or
private messages, i.e., racist, abusive, sexually explicit, threatening, demeaning,
stalking, or slanderous.
p. Falsifying permission, authorization, or identification documents.
q. Obtain copies of or modify files, data, or passwords belonging to other users on
the network.
r. Knowingly placing a computer virus on a computer or network.
3. Acceptable Use General Guidelines
a. Students will have access to all available forms of electronic media and
communication, which is in support of education and research and in support of
the educational goals, and objectives of the Alva Independent School District.
b. Students are responsible for their ethical and educational use of the computer online services at the Alva Independent School District.
c. All policies and restrictions of the Alva Independent School's network and
computer resources must be met.
d. Access to the Alva Independent School's network is a privilege and not a right.
e. Each employee, student, and/or parent will be required to sign the Acceptable
Use Policy Agreement and adhere to the Acceptable Use Guidelines in order to
be granted access to Alva Independent School’s network and computers.
f. The use of any Alva Independent School District computer must be in support of
education and research, and in support of the educational goals and objectives of
the Alva Independent School District.
g. When placing, removing, or restricting access to specific databases or other
computer on-line services, school officials shall apply the same criteria of
educational suitability used for other education resources.
h. Transmission of any material, which is in violation of any federal or state law, is
prohibited. This includes, but is not limited to: confidential information,
copyrighted material, threatening or obscene material, and computer viruses.
i. Any attempt to alter data, the configuration of a computer, or the files of another
user without the consent of the individual, campus administrator, or technology
administrator, will be considered an act of vandalism and subject to disciplinary
action in accordance with Board Policy.
j. Any parent wishing to restrict their children's access to any computer or on-line
services will provide this restriction request in writing. Parents will assume
responsibility for imposing restrictions only on their own children.
4. Network Etiquette
a. Be polite.
b. Use appropriate language.
c. Do not reveal personal data (home address, phone number, and phone numbers of
other people).
d. Remember that the other users of Alva Independent School's network and
computer resources are human beings whose culture, language, and humor have
different points of reference from your own.
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5. E-Mail
a. E-mail should be used for educational or administrative purposes only.
b. E-mail transmissions, stored data, transmitted data, or any other use of the Alva
Independent School's network and computer resources by students, employees, or
any other user shall not be considered confidential and may be monitored at any
time by designated staff to ensure appropriate use.
c. All e-mail and all contents are property of the District.
6. Consequences
a. The student, in whose name a system account and/or computer hardware is
issued, will be responsible at all times for its appropriate use.
b. Noncompliance with the guidelines published here in the Student Acceptable Use
Guidelines and in Board policy may result in suspension or termination of
technology privileges and disciplinary actions.
c. Use or possession of hacking software is strictly prohibited and violators will be
subject to disciplinary action.
d. Violations of applicable state and federal law will result in criminal prosecution,
as well as disciplinary actions by the District.
e. Electronic mail, network usage, and all stored files shall not be considered
confidential and may be monitored at any time by designated District staff to
ensure appropriate use.
f. The District cooperates fully with local, state, or federal officials in any
investigation concerning or relating to violations of computer crime laws.
g. The Oklahoma Open Records Act governs contents of e-mail and network
communications; proper authorities will be given access to their content.
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Student Section
_______________________________________________
Student Name (print)
_______________________________________________
Grade
I have read the Student Acceptable Use Guidelines. I agree to follow the rules contained in
this policy. If I violate the rules I will lose my access privilege to the Alva Independent
School's network and computer resources and may face other disciplinary action.
_______________________________________________
Student Signature
_______________________________________________
Date
Parent Section
I have read the Student Acceptable Use Guidelines. I understand if my child violates the
Acceptable Use Guidelines, his or her access privilege to Alva Independent School's network
and computer resources will be revoked and he or she may be subject to disciplinary action.
I also grant permission for examples of my child's schoolwork to be published on the World
Wide Web as an extension of classroom studies, provided that the home address, home phone
number, or student's last name are not disclosed.
Note: Parents, who do not want their child to have Internet access and/or have their
schoolwork published on the web, should submit this request in writing annually to their
child's principal.
_______________________________________________
Parent or Guardian signature
_______________________________________________
Date
_______________________________________________
Parent name (print)
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PLEASE PRINT ALL INFORMATION
Student Name _________________________
Last Name
Parent Name
_________________________
Last Name
______________________
_______________________
First Name
Student ID#
______________________
_______________________
First Name
Social Security or Driver’s License#
Student Email Address ______________________________________________________________________
Parent Email Address _______________________________________________________________________
Address __________________________________________________________________________________
Home Phone __________________________
Work Phone ______________________________________
DISTRICT TAKE-HOME TERMS AND CONDITIONS:
Before your student can have home access to their computer, the following criteria must be met:
1. This form must be completed in full and signed by parent/guardian and student.
2. Insurance options will be available soon.
3.
By signing this document, you agree to abide by the Districts Acceptable Use Policy, and understand
that violation of this policy may result in the total loss of use of the Laptop (with no insurance refund).
4.
Inappropriate use of the computer may also result in discipline, including suspension as set forth in
policy.
5.
The use and possession of the property terminates the Last Calendar Day of This Current School Year
(or earlier if deemed necessary by the administration).
6.
At the end of the school term, the computer, carrying case, power brick, and cord will be returned in
good condition (without marks, glue, tape, stickers, graffiti, cuts, etc).
7.
If the Laptop is not returned by the last day of classes, it will be considered lost or stolen.
8.
The Laptop, Bag and Power Brick is the sole property of the Alva Independent District.
9.
Missing or damaged items should be reported immediately and replaced at the expense (if any) of the
student. Holds may be placed on transcripts and or records until replacement costs are paid.
By signing this form you are agreeing to the terms and conditions as set forth above.
Signatures
_______________________________
Parent/Guardian Signature
____________________________________
Student Signature
_________________
Date
OFFICE USE ONLY: Insurance Premium Receipt Number:
STUDENT & PARENT LAPTOP AGREEMENT
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