FAMILY HANDBOOK 2016-17 Back-to-School Information and Resources
CONTENTS 4| Information 6| Health and Wellness 8| Family Communications 10| Food & Nutrition 12| Be Involved 14| Calendar 16| Early Release Days 18| Free Lunch Information 21| Student Info Release 22| Health Insurance 23| Immunization Information
BACK TO SCHOOL SCHOOL STARTS AUG. 29/30
Please check with your school for detailed back-to-school information and additional August events. Open House/ Get Connected Days
Elementary teacher assignments and bus route information posted to Infinite Campus at 8 a.m. Wednesday, August 10 Get Connected Day, Valley View Tuesday, August 16 Get Connected Day, South View Wednesday, August 17 Get Connected Day, Edina High *At Valley View, South Gym Wednesday, August 24 Open House, Edina Family Center Thursday, August 25 Open House: Concord, Countryside, Cornelia, Highlands, Normandale Friday, August 26 Open House, Creek Valley Monday, August 29 First Day of School: Grades 1-12 Tuesday, August 30 First Day of School: Kindergarten, Edina Family Center and ECSE
SUPERINTENDENT’S MESSAGE Welcome to the 2016-17 school year! A new school year is upon us and as retail stores stock their shelves with school supplies, so too are we readying our classrooms and staff with the supplies they will need for a successful school year. Included in these preparations are both program advancements and facility updates that are part of our Next Generation Strategic Plan implementation. Here you will find our annual Family Handbook, a critical resource to encourage continued partnership between the district and families. Inside is information about district services, programs and policies, ways that we will communicate with you and your family, and ideas on how you can be involved. We hope this Handbook will continue to be a resource for you throughout the year. Despite the piles of dirt and construction vehicles at our schools, know that we will be ready to welcome you to a new school year soon. We look forward to seeing you in a few weeks at back to school events and for the exciting first days of school. Together, we will continue to create an educational environment that inspires all of our learners and helps them find their success at school and in the world.
Ku soo dhawaada sannad-dugsiyeedka 2016-17! Sanad dugsiyeedkan cusub halka eey dukaamada ku buuxinayan kaydadka armaajooyinkooda alaabta dugsiga, sidoo kale inaguna waxaan u diyaarineynaa fasallada iyo shaqaalaha sahayda ay u baahan doonaan muddo sannad ah. Mid kamid ah diyaarinta waa horumarka barnaamijyada iyo macluumaadka xarunta in ay yihiin qayb ka mid ah hirgelinta “Next Generation” ama Qorshaha Istiraatiijiga ah. Halkan waxaad ka heli doontaa sanad laha Buuga gacanta ee Qoyska, kayd muhiim ka ah dhiirigalita iskaashiga u dhaxeeya degmada iyo qoysaska. Waxaan rajaynaynaa Handbooga in uu sii ahaan doono mid idin anfaco sanadka oo dhan. In kastoo dugsiyadeena qaar, eey dhisma xoog leh kasocdaan, ogoow inaynu diyaar u noqon doono sanad dugsiyeedka cusub. Waxaan rajeyneynaa in aan isku aragno dhowr toddobaad ka dib dhacdooyinka dugsiyada iyo maalmaha koowaad ee dugsiga. Wadajir, waxaan sii wadi doonaa in la abuuro jawi waxbarasho oo dhiiri galiya dhamaan ardayda si eey ugu aflaxaan dugsiyadda iyo dunida oo dhan.
¡Bienvenidos al año escolar 2016-17! Un nuevo año escolar está aquí y mientras las tiendas están surtiendo sus anaqueles con materiales escolares, igual nosotros estamos alistando nuestros salones de clases y personal con los materiales que se necesitaran para un año escolar exitoso. Incluyendo en estos preparativos están tanto los progresos en los programas como las actualizaciones de las instalaciones que son parte de la implementación de nuestro Plan Estratégico de la Siguiente Generación Aquí tiene nuestro Instructivo Familiar anual, un recurso importante que fomenta la alianza continua entre el distrito y las familias. Esperamos que este Instructivo continúe siendo un recurso para usted a lo largo de todo el año. Sin importar las pilas de tierra y vehículos de construcción en nuestras escuelas, le informamos que vamos a estar listos para darles la bienvenida a nuestro nuevo año escolar muy pronto. Esperamos verlos en unas cuantas semanas en los eventos de regreso a clases y en los emocionantes primero días de clases. Juntos vamos a continuar creando un ambiente educativo que inspire a todos nuestros alumnos y que los ayude a encontrar el éxito en su escuela y en el mundo. Warmest regards, Salaan diirran, Saludos calurosos, Ric Dressen, Superintendent superintendent@edinaschools.org
The mission of Edina Public Schools, working in partnership with the family and the community, is to educate all individuals to be responsible, lifelong learners who possess the skills, knowledge, creativity, sense of selfworth, and ethical values necessary to thrive in a rapidly changing, culturally diverse, global society.
CONNECT WITH US
VISION edina public schools will continue to be among the premier school districts both nationally and internationally. our high expectations in academics, arts, extracurricular activities and community involvement best prepare each learner to achieve success in college, career and life.
core strategies
Edina Public Schools believes every student should have equal access to educational opportunities. And we know that parent and family involvement with school contributes to student success. To help you connect with your child’s school and be involved in their education, we provide translation and interpretation services to meet your family’s language needs at school and with district-related programs or communications. If you would like language assistance with a message you have received; an interpreter for a school meeting, conference or phone call; or want to know more about the district’s translation and interpretation services, please contact our Student Enrollment Center at: enrollment@edinaschools.org or 952-848-4585. Dugsiyada Dadweynaha Edina ayaa aaminsan in arday kasta uu si siman u helo fursado waxbarasho. Oo waxaannu ognahay in ku lug lahaanshaha dugsiga ee waalidka iyo qoyska kordhinayso guusha ardayga. Si lagaaga caawiyo in aad ku xirnaato dugsiga ilmahaaga iyo inaad ka qayb qaadato waxbarashadooda, waxaan bixinaa adeegyo turjumida afka qoyskaaga ee ku saabsan dugsiga iyo barnaamijyada ama isgaarsiinta la xiriira degmada.
Personalized Learning Experiences for all Students
coherent and comprehensive educational programs
effective and valued district partnerships
EDUCATIONAL COMPETENCIES THE PROFILE OF A NEXT GENERATION LEARNER
Haddii aad jeclaan lahayd kaalmada luqadda fariin aad heshay; qof turjubaan kuu noqdo la kulanka dugsiga, shirka ama telefoon ka, ama aad rabto inaad wax badan oo ku saabsan adeegyada turjumidda iyo fasiraadda ee degmada ogaato, fadlan la xiriir: Xirriirka Bulshada ee EPS, Abdul Abdullahi - abdul. abdullahi@edinaschools.org ama 952-848-4051 Las Escuelas Públicas de Edina creen que cada estudiante debe tener el mismo acceso a las oportunidades educativas. Y sabemos que el involucramiento de los padres y las familias con la escuela contribuyen al éxito del estudiante.
Healthy, Well-Rounded Individual
Responsible, Engaged Citizen
Motivated Life-long learner
Effective communicator & collaborator
Globally Competent Individual
Innovative Thinker & Creator
Para ayudarle a conectarse con la escuela de su hijo y estar involucrado en su educación proporcionamos servicios de intérpretes y traducciones para cubrir las necesidades de lenguaje de su familia así como programas o comunicaciones relacionados con el distrito. Si necesita apoyo con algún mensaje que haya recibido, con un intérprete para alguna junta de la escuela, conferencia o llamada telefónica, o si quiere saber más acerca de los servicios de intérpretes y traducciones del distrito, por favor contacte a: Blanca Díaz de Leon, Enlace Cultural en Español de las Escuelas de Edina en blanca.diazdeLeon@edinaschools. org o al 952-848-4052.
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FAMILY INFORMATION BACK-TO-SCHOOL INFORMATION
Over the next several weeks you will receive additional information on specific schools, programs and services, including individual school information. Bus route and classroom assignment information will be posted on the parent portal (Infinite Campus) at 8 a.m. on the day of your school’s Open House/Get Connected event. Please check district and school websites for more information.
HEALTH PROMOTION & CARE
Health services are provided for students during the instructional day at each school site. Students are required to be in compliance with the Minnesota School Immunization Law (see page 23). Some students may require prescription and non-prescription medication during the school day. Medication may only be administered by a licensed school nurse or trained school personnel. For more important health information, visit www.edinashools.org/healthservices
DIGITAL PARENTING RESOURCES
We understand that parenting in a digital age can be overwhelming. EPS provides numerous resources to help you and your child operate safely in a digital world. Resources include information about filters and protections, cell phone use, and a free online course about basic Internet safety and how to create a positive digital footprint. Visit edinaschools.org/elearning2.
CHEMICAL/TOBACCO FREE
All EPS property, school sites and school-related activities are chemical and tobacco free.
MEDICAL, HEALTH & ACCIDENT
The district does not purchase medical, health or accident insurance for students. If a student has an accident, becomes ill, or is injured while at school or participating in district-sponsored activities, families will need to access their own insurance plans to cover any associated costs (e.g. medical care, emergency transportation). The district cannot pay these associated costs. Questions about insurance can be directed to Margo Bauck, director of business services at 952-848-4916 or margo.bauck@edinaschools.org.
EMPLOYEE BACKGROUND CHECKS
In accordance with Minnesota State Statutes, all applicants who have been offered a position with the school district must complete a criminal background check as part of the process for determining employment. The district may also elect to do background checks of volunteers, independent contractors and student employees in the district. Questions about employee background checks can be directed to Gwen Jackson, director of human resources and operations, at 952-848-4946 or gwen.jackson@edinaschools.org
ONLINE ACCEPTABLE USE
Through the Internet, students have access to a world of online resources and learning experiences. Parents/ guardians must provide approval for their child(ren) to access Internet resources at school, and students must agree to follow the district’s Acceptable Use Policy (District Policy 634). Consent forms are required for families with students new to the district and for those with students entering grades 3, 6 and 10. The form is available online at edinaschools.org/parents and at edinaschools.org/ students, click on Student Rights and Responsibilities.
BULLYING PREVENTION EPS is committed to ensuring a safe and civil learning environment for all students, families and staff. Bullying, like other violent or disruptive behavior, is conduct that interferes with students’ ability to learn and teachers’ ability to educate students in a safe environment.
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In accordance with Minnesota law, school staff and volunteers received training on the prevention of bullying, as well as clarification and enhanced definitions of bullying. The district’s policy on bullying prevention (District Policy 514) includes additional definitions of bullying, training expectations, reporting procedures and protocols and district responsibilities.
STUDENT RIGHTS & RESPONSIBILITIES HANDBOOK A safe, secure and welcoming learning environment is essential to helping our students be successful learners. EPS has developed comprehensive policies and procedures that define student rights and responsibilities and ensure a positive learning environment. These expectations are outlined in the Student Rights and Responsibilities Handbook, which includes information regarding: • • • •
Attendance Technology Use Field Trips and Travel Grading and Reporting
• • • •
Homework Student Discipline policy Bus Rider responsibilities And more
The full Student Rights and Responsibilities Handbook is available online at edinaschools.org/students. Families may also request a copy from their school office. Teachers will review the handbook with students at the beginning of the school year. Parents/guardians are also asked to review the handbook with their child(ren) at home. Please check parent and student resource pages of the district website for a translated version of the Student Rights and Responsibilities Handbook. Fadlan fiiri bogga waalidka iyo khayraadka ardayga bogga internetka ee degmada turjumaada buuga Xuquuqda iyo Mas’uuliyadaha Ardayga. Por favor revise las páginas de recursos de los estudiantes del sitio del distrito para una versión traducida del Instructivo de los Derechos y Responsabilidades de los Estudiantes.
EPS FAMILY CHECKLIST o Login to Parent Portal (see page 8)
Credentials arriving by U.S. mail in early August
o Be sure EPS has your current family
contact information
o Check your child’s lunch account in FeePay o Confirm your child’s immunization information is up to date o Attend your school’s Open House or
Get Connected Day
Visit the InfiniteCampus demonstration area!
COMMITMENT TO EQUITY The district’s All for All mission is a simple concept: all of us – district staff and administration, students, families and community – working to provide educational opportunities for all learners so they are successful in school, work and life. Accomplishing this mission is complex. Providing equal access to educational opportunities means we must recognize and eliminate barriers that stand between students and success, particularly barriers rooted in race and culture. As we prepare students to be successful in what our mission statement describes as a “rapidly changing, culturally diverse, global society,” we recognize that this world also exists close to home, in our own school district and the broader Edina community. To prepare students for an outside world of diversity and change means we must first turn the lens of racial equity and cultural competence toward ourselves. EPS Equity Journey During the past school year, the district has studied and begun to implement culturally responsive teaching methods so that all students feel recognized and accepted in our schools and empowered to pursue their own success. Teaching in this way is one resource that can help close the achievement gap that exists for students who are disadvantaged by race or economic status. It also helps all students understand the importance of cultural and global competence, a key skill needed for post-secondary success. Additionally, two cultural liaisons joined our staff last fall to support and encourage the involvement of our Spanish and Somali families, the district’s two largest ethnic groups. They also work with all district staff to better understand the unique needs of these communities. A community conversation about cultural responsiveness held in early March invited all members of the Edina community to join the dialogue about how to create and sustain a welcoming community environment for all families. And our continuing work to embed personalized learning strategies across all grade-levels and curriculum is resulting in students who are more engaged and passionate about their learning. Our equity journey is ongoing and our work will continue this year with additional trainings and engagement opportunities for students, families and staff. By incorporating diverse voices and perspectives, we move closer to truly achieving our mission of all of us partnering to provide education opportunities for all learners that are comprehensive, innovative, personalized, and culturally conscious. For more information contact Mary Manderfeld, director of equity and enrollment at mary.manderfeld@ edinaschools.org or 952-848-4961.
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HEALTH + WELLNESS IMMUNIZATION REQUIREMENTS For newly enrolled students and those entering kindergarten and 7th grade In order to attend school in Minnesota, state law requires students entering kindergarten, 7th grade, and those newly enrolled to EPS to show proof of required immunizations or to file legal exemptions from immunizations with the school. You may review your child’s school immunization record through your Infinite Campus account (accessible at edinaschools.org/ parents). A schedule of required immunizations is also located on the EPS website under health services. •
•
You will be contacted if immunization information is needed in order for your child to attend school. Updated or new immunization information should be sent to your child’s school health office no later than Friday, Aug. 5 to allow time for processing. Immunization clinics are held at Bloomington Public Health, 1900 W. Old Shakopee Road in Bloomington, Minn. All uninsured or underinsured children are welcome. Call for times: 952-563-8900
If you have questions about immunization requirements, contact your child’s school health office or Mary Heiman, EPS Health Services Coordinator at 952-848-4890 or mary.heiman@edinaschools.org.
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The mission of Edina Public Schools Health Services is to promote optimal health for optimal learning. ILLNESS
Your child should not come to school if he/she has had: • a fever of 100 degrees or more, the student should stay home for 24 hours after the temperature returns to normal without fever reducing medication such as ibuprofen or acetaminophen. • has vomited or had diarrhea, the student should stay home until 24 hours after the last episode. • has had any rash that may be disease-related or the cause is unknown, check with your health care provider before sending the student to school. Call the Attendance Line at your child’s school when your child is absent due to illness. Notify your school’s health office if your child has a condition that may impact others, such as strep throat, chickenpox or head lice. When students become ill or are injured during the school day, parents/guardians are contacted first. If a parent/guardian cannot be reached, a call is made to other individuals listed on the student’s emergency forms. Students will not be released unless accompanied by a responsible adult. It is expected that students will be picked up within one hour of the call to the parent/guardian.
MEDICATIONS AT SCHOOL
Whenever possible, medications should be given during non-school hours. When it is necessary for a student to receive medication during the school day, the student must bring the following for each medication: • Medication in the original container with directions; • Written permission from the parent/guardian; and • A written order from the physician for all medications including over the counter medications for pain or relief of cough. All medications must be kept in the Health Office unless special arrangements (e.g. emergency epipens or inhalers) are made with the Licensed School Nurse (LSN). Please contact your school’s health office to obtain medication authorization forms.
CHILDREN WITH CHRONIC HEALTH CONDITIONS Parents should consult with the LSN if they have a child with a diagnosed chronic health condition such as asthma, diabetes, seizures or severe allergies. The nurse, student and family will work with the child’s health care provider to establish a health plan that will assist school staff in understanding and accommodating the student’s health needs.
ANNUAL HEALTH & SAFETY NOTIFICATIONS Use of pest control materials:
Edina Public Schools uses a licensed, professional pest control service firm for the prevention and control of rodents, insects and other pests in and around the district’s buildings. Their program consists of: • • • •
Inspection and monitoring to determine if pests are present and whether any treatment is needed; Recommendations for maintenance and sanitation to eliminate pests without need for pest control materials; Utilization of non-chemical measures such as traps, caulking and screening; and Application of EPA-registered pest control materials when needed.
Pests can sting, bite, cause contamination, damage property and spread disease; therefore, we must prevent their presence and control them as necessary. The district or outside contractors may also apply herbicides on district properties, as deemed necessary. The long-term health effects on children from the application of pest control materials may not be fully understood. All pest control materials are chosen and applied according to labeling directions per Federal law. An estimated schedule of pest control inspections and possible lawn treatments are available for review. Parents of students may submit a request to receive prior notification of any application by calling the school principal or the Buildings and Grounds Department at (952) 848-3999. Material Safety Data Sheets for all pesticides and herbicides utilized are available for review by calling the Buildings and Grounds Department.
Asbestos Notification for Staff and Building Occupants:
The Asbestos Hazard Emergency Response Act (AHERA) requires that each school district notify workers and building occupants annually regarding asbestos-related activities. Until the late seventies, asbestos was commonly used in commercial and residential building materials, such as floor tile, fireproofing spray and thermal system insulation on pipes, tanks and boilers. In the late 1980’s, all school buildings were inspected for asbestos-containing building materials according to AHERA protocol, using accredited inspectors.
Based on the results of these inspections, management plans were developed for each school where asbestos was found. These plans are on file at the Edina Community Center and are available for review by contacting the Buildings and Grounds Office at (952) 848-3999. AHERA also requires that we conduct periodic surveillance inspections every six months to evaluate the condition of asbestos-containing materials and that we completely re-inspect our buildings every three years. This is done to best ensure all asbestos-containing materials are maintained in a safe condition. Identified below are asbestos-related activities that were completed over the past year or are planned for the upcoming year. Complete details are available upon written request and copies of inspections are available at each individual school.
ACTIVITIES SCHEDULED FOR 2016-17
Periodic surveillance Abatement activities at Highlands, Countryside and Cornelia elementary schools; Valley View and South View middle schools; and Edina High School associated with renovation projects Three-year re-inspection
The district is committed to providing a safe and healthy environment for our building occupants and employees, to include ongoing efforts related to the management and control of asbestos-related materials.
Indoor Air Quality
To help improve our school environment and comply with requirements established by the Minnesota Department of Education (MDE), Edina Public Schools has developed and implemented an Indoor Air Quality Management Plan that addresses indoor air quality issues throughout the district. Walkthroughs and inspections of district buildings are performed annually to detect current problems and help prevent future problems from occurring. Specific district information is available upon request from the Buildings and Grounds Department at (952) 848-3999. General information regarding indoor air quality is available from the Department of Health at: www.health.state.mn.us/divs/eh/indoorair/schools/
DISTRICT STUDENT MENTAL HEALTH SERVICES EXPANDED The U.S. Department of Health estimates that approximately 20 percent of students between the ages of five and 18 currently struggle with a diagnosable mental health condition. Surveys of students in Edina Public Schools indicate chronic stress concerns with students in numerous grade levels. Chronic stress is known to impact the ability to communicate and problem solve, suppress the immune system, cause social impairment and increase absenteeism, all of which negatively impacts learning.
student services on-site at each of the district’s schools.
who want more information on how to assist students at home and in the community.
Fraser Clinic will work with early childhood and elementary schools, and Family Innovations, Inc., will support middle and high school students. Both groups will establish services that can be provided during the school day for parents wishing to access services for their students. These services will begin in the fall and will slowly increase in scope as service needs are identified.
Recognizing this growing need, this fall the district will expand the mental health resources available to students and families by partnering with two mental health providers to offer
Also new this year, district social work services will be expanded to support early childhood families. Also, additional in-depth trainings will be available to district staff and parents
The district has long maintained a continuum of services for students at each school site to meet their unique social and emotional needs, including general and specific training with classroom teachers, access to school social workers, psychologists and health services staff, and in some cases, special education teachers. These added mental health services will help provide a new tier of support for students and families. Watch for more information about mental health support at your students’ schools.
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FAMILY COMMUNICATION New technologies streamline parent access to information Login credentials to be sent to families via U.S. mail in early August Over the summer, the school district implemented two new technology tools designed to allow better utilization of the district’s student information system and better access to online learning tools and classroom resources. Infinite Campus is the new student information system and parent portal, replacing TIES/SchoolView. Infinite Campus provides the same student information but in a more user-friendly appearance and with some built-in messaging to more easily facilitate communication between teachers and parents. Schoology is the district’s new learning management system, replacing Moodle. When the switch to a new student information system became necessary, the district explored options for a learning management system that would integrate most effectively with Infinite Campus. Schoology was selected for its focus on collaboration and the design of its learning tools. Over the past several months, course content has been migrated from the old Moodle system to Schoology for use this fall. New login credentials for the parent portal will be mailed to parents. Tutorials on how to navigate the new system are available on the district website in the Parent Resources section. Demonstrations of the new system and new user training will also be available at Get Connected and Open House days at all schools. Go to www.edinaschools.org/parent for more information.
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Edina Public Schools places a high value on the connections we have with students, families, and the community. Because effective communication is critical to strong partnerships and engagement, we provide a wide variety of ways to communicate with stakeholders and grow these important relationships. The school district uses several online technology tools to communicate information, including student progress reports and grades, school communications and emergency information. Families who do not have Internet access should contact their respective schools to arrange to receive information in other ways. Degmada dugsi ayaa isticmaalaa dhowr ka mid ah qalabka teknoolijiyada online si loo ogeysiiyo xogta, oo ay ku jiraan warbixinta ardayga, horumarka fasalada, isgaarsiinta dugsiga iyo macluumaadka xaaladaha degdegga ah. Qoysaska aan laheyn Internet waa inay la xiriiraan xirriiriyaha Bulshada Soomaalida si aad u sameysato sidi aad ku heli lahayd macluumaadka siyaabo kale. El distrito escolar usa varias herramientas en línea para comunicar información, incluyendo reportes del progreso del estudiante y calificaciones, las comunicaciones de la escuela e información de emergencia. Las familias que no tienen acceso al internet deben contactar a los enlaces culturales (Blanca-Español/Abdul-Somalí) para ponerse de acuerdo y recibir la información de otras maneras.
NEWSLETTERS
Much of the information you receive about your students’ activities and schools will come in the form of a newsletter. Each school and often teachers, send an electronic newsletter to families on varying schedules to keep parents in the loop on what is happening. Additionally, the district publishes the following newsletters: IN THE KNOW - biweekly electronic newsletter sent to all district families via email on alternating Thursdays. It includes stories and photos about students and classrooms, district and construction updates, studentwritten articles, news from the school board, notices of important meetings and a calendar of activities. EPS EXPERIENCE - quarterly, printed newsletter mailed to all EPS residents. This newsletter includes stories about strategic initiatives, community partnerships, district finances and more.
NEWS
NEXT GEN NEWS – a periodic video publication that highlights stories of the implementation of the district’s Next Generation Strategic Plan. Through digital storytelling, NGN offers a unique look inside EPS classrooms and programs.
TRANSITION NEWSLETTERS -- sent to parents of soon-to-be kindergarten and incoming middle schoolers. Countdown to Kindergarten and Movin’ on to Middle School offer advice from teachers, students, parents and counselors about how to prepare your student -- and you -- for the educational transition that will happen in the next school year. These newsletters arrive via email periodically from January through August.
WEBSITE
New information is added to the district website almost daily. Watch the rotating announcements and Current Headlines on district and school home pages for the latest updates. The district website is also your source for information about academic programming, strategic plan implementation, construction updates, school board policies and meeting information, newsletter archives, and more. You will also find links to school and Community Education Services (CES) websites. Visit edinaschools.org
CALENDARS
While the district partners with local business to produce an annual activity calendar available to EPS families (limited quantities available at each school site), the district’s online calendars have the most current information about important dates in the district and events at your students’ schools. Customizable online calendars show the events that are most important to your family, which can be downloaded to your personal or mobile calendar. Find information on how to customize calendars for your devices at edinaschools.org/calendar
SCHOOLMESSENGER
This electronic notification system is used by EPS to send direct messages via email, voicemail or text message to district families and staff. The district uses this system to communicate emergency information quickly as well as important messages and alerts. Schools and programs also use this system to send families important information and reminders. SchoolMessenger integrates with the district’s student information system, so be sure your school has your most current contact information on file.
OTHER PUBLICATIONS
Throughout the course of the year, the district produces a number of other specialized publications such as the Annual Report, Activities Calendar, Kindergarten Registration and the Family Handbook that you are holding. Each one provides information to help you be involved in your student’s education and engaged in the work of the school district.
SOCIAL MEDIA
The Next Gen Facilities Plan was developed to align with and support the strategic advancement of the district’s Next Generation Strategic Plan, which focuses on personalized learning for all students and ensuring they have the skills necessary to thrive in a rapidly changing, global world. Last spring, the facilities plan entered the construction phase that will extend to fall 2018. These construction projects are supported by the community through its approval of a $124.9 million bond referendum in May 2015. Planning and design of all projects have involved core planning teams that included staff, students, parents, and community representatives. As with any construction project, there will be periods of disruption and inconvenience. Working around the needs of students and providing a safe learning and working environment is our highest priority. The district is also committed to minimizing disruption to neighbors and visitors whenever possible. To that end, we have established multiple ways for you to stay in the loop with construction progress. Periodic Construction Update e-newsletters are distributed to families and subscribers. These include current status updates on construction projects around the district and provide an up-close look at progress through interviews, photographs and videos.
New posts on the district’s Facebook and Twitter profiles happen almost everyday. Fun photos, links to news, and event reminders help keep you in the loop on what is going on around the district. Our YouTube site features video updates and newsletters, and school board meetings. Photo albums are posted on our Flickr site. Like us on Facebook at Edina Public Schools, and follow us on Twitter @edinaschools.
Additional ways to stay up-to-date on EPS construction progress:
SCHOOL BOARD VIDEOS
Follow us on Facebook: @ EdinaPublicSchools
Videos from all regular meetings of the School Board are posted on the district website. Visit edinaschools.org/schoolboard to learn more.
Construction Update blog edinaschools.org/constructionupdate Follow us on Twitter @EPSConstruction
Email: construction@edinaschools.org Call: 952-848-4038
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FOOD + NUTRITION Edina Public Schools (EPS) contracts with Chartwells to facilitate its food service program, which is part of the National School Nutrition Program offering foodbased combo meals. Combo meals are required to meet specific nutritional guidelines established by the Federal Government. Several different entrees and sides are offered each day for lunch. Breakfast is available at school before the start of classes. Menus are posted on the website and within school buildings. ALL STUDENTS HAVE A LUNCH ACCOUNT. IF YOU DO NOT WANT YOUR STUDENT TO PURCHASE LUNCH, YOU MUST FILL OUT A MEAL RESTRICTION FORM TO CLOSE THEIR ACCOUNT. We will not deny a child a combo meal unless we have a restriction form online. A breakfast combo is comprised of three components, one of which must be a fruit. A lunch combo meal is comprised of five components: vegetable, fruit, protein, grain and milk. Students must choose three of these components, and one of the three must be a fruit or vegetable. They may choose up to five different components. If the student does not select this combination of food, we cannot charge it as a combo meal by federal government regulations. Each item will be charged separately at a la carte prices, and if more than five components are taken the additional items are charged a la carte prices. Parents may request restrictions for combo meal purchases only or they can limit spending to a specific dollar amount per day. Families interested in restricting their child’s meal account should complete a “meal account restriction form,” which can be found online at edinaschools.org/food. MEAL ACCOUNTS AND ONLINE PAYMENTS The district uses an individual meal accounting point of sale system. Each student has his or her own individual account. Accounts are debit accounts, and therefore, there must be money in the account in order for the student to use it. Deposits to student lunch accounts may be done in several ways: • •
Online through FeePay, the district’s new one-stop student account system accessible through the Infinite Campus parent portal By check: For a single account, give to cashier in cafeteria, drop off at school office, or mail to district food service office. Checks to be split among several accounts must have allocation amounts identified by student name and school and mailed to the food service office. Make checks payable to ISD #273 Nutrition Program; mail to Food & Nutrition Services, Edina High School, 6754 Valley View Road, Edina MN 55439.
If a student’s meal account holds a negative balance, they will be offered a regular meal, including extras or ala carte. You may sign up to receive low balance notifications via email on FeePay. For additional questions about account balances or activity, contact the Food Service Office at 952-848-3811. STUDENT ID AND PERSONAL IDENTIFICATION NUMBERS Elementary and middle school students receive a Personal Identification Number (PIN) at school to access their meal account. The same number is used throughout elementary school, with a new PIN provided to students in middle school. Meal account balances transfer from year to year, through high school. High school students can also present their student ID to the cashier to access their account. QUESTIONS If you have any questions or FREE MEAL PROGRAM comments, please contact Families with limited incomes may qualify for their students to receive free lunches and breakfasts at school. All Chartwells Administrative Assistant kindergarten students qualify for free breakfasts regardless of family income. To apply for free school meals, complete Joanne Meyer at 952-848-3811 or the application on page 19. A new application must be submitted each year. If you don’t qualify now, you may apply at joanne.meyer@edinadschools.org. any time during the school year. Additionally, your application helps the district qualify for education funds and discounts and is often used in awarding scholarships to students for participation in classes, activities and programs. If you have questions regarding special diets or allergies, please * Until applications are processed, you are responsible for any meals that are purchased prior to acceptance of contact Chartwells Resident application. Please reapply every year. Dietician Alexandra Crapser at 952-818-3812 or Alexandra. crapser@compass-usa.com
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Breakfast 1.60 $
Kindergarten eats free
Lunch 2.70 $
Breakfast 1.70 $
SECONDARY
ELEMENTARY
MEAL PRICING INFORMATION
Lunch Combo 2.85 $ Premium Combo 3.40 $ A la carte items also available
Milk .60 $ SUPERFOOD TASTINGS STUDENT FAVORITE Apple Cranberry Kale Salad Everyone has heard of the word superfood. No these foods don't have super powers, but they are packed full of vitamins and minerals that help your body grow. Kale is one of these superfoods and can be enjoyed in many different ways. Try this delicious kale salad with apples, cranberries and sunflower seeds. Makes 4 servings
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FREE LUNCH QUESTION + ANSWER
Who can get free school meals? Children in households participating in the Supplemental Nutrition Assistance Program (SNAP), Minnesota Family Investment Program (MFIP) or Food Distribution Program on Indian Reservations (FDPIR), and foster children, can get free school meals without reporting household income. Children also qualify for free school meals if their household income falls below the maximum income shown for their household size (see page 18). Do foster children qualify for free meals? Yes, foster children who are the legal responsibility of a foster care agency or court are eligible for free meals regardless of household income. Please complete an application identifying the children who are in foster care. I get support from WIC. Can my children get free meals? Children in households participating in WIC may be eligible for free meals. Please fill out an application.
May I apply if someone in my household is not a U.S. citizen? Yes. You or your child does not have to be a U.S. citizen to qualify for free meals. Who should I include as household members? Include yourself and all other people living in the household, related or not (e.g., grandparents, other relatives or friends). What if my income is not always the same? List the amount that you normally get. If you normally get overtime, include it, but not if you get overtime only occasionally.
Ingredients:
How will the information I provide be kept? Information you provide on the form, and your child’s approval for school meal benefits, will be protected as private data. See the back page of the Application for Educational Benefits for more information about how the information you provide is used.
Directions:
Will the information I give be verified? Yes, and we may also ask you to provide written documentation.
1/2 cup diced Granny Smith Apple 4 1/2 cup chopped Kale 1/4 cup dried Cranberries 1/3-1/2 cup Italian Dressing 2 Tbsp Sunflower Seeds 1. Wash all produce. Toss chopped kale, diced apple, and dried cranberries with Italian dressing. 2. Garnish with sunflower seeds. Serve immediately or store in fridge until ready to serve.
If you have other questions or need help, please contact Dan Hutchinson at daniel.hutchinson@edinaschools.org or 952-848-3813.
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BE INVOLVED Edina Public Schools is strongest when the ideas, energy and voices of all stakeholders are included in planning and decision-making. Throughout the year there are many ways for you to be involved with the school district. Watch for these and other opportunities to be announced on school and district websites and through various district communication channels.
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PARENT ORGANIZATIONS
TASK FORCES
DIALOGUES AND FORUMS
Each school and program, from early childhood through high school, has a parent involvement organization (PTO/ PTA) that serves to support students, families, teachers and administration through events and volunteer opportunities. The leadership of each parent organization is also part of the district’s Parent Leadership Council (PLC). Meeting monthly throughout the school year, the PLC works closely with district leadership to discuss updates on projects and initiatives, and providing a parent voice in district discussions and decision-making. Check your school’s website or newsletter for information on parent organization meetings at your building.
From time to time, the district forms a task force specific to a project, program or district-wide need. Most often task forces include members representing parents, community, teachers, and staff. Last year district established task forces addressing budget alignment, facility and construction planning, and mental health programs. This year, task forces are planned for exploration of school start and end times, as well as planning for gifted services.
At key points in program development the district may hold a community dialogue so that interested stakeholders can learn more about the status or direction of key initiatives, hear updates and provide input for decision making. Last year, dialogues were held to inform program planning for early education programming, and services for gifted and talented learners. In addition, candidate forums were held as part of the selection and hiring process for new principals and an assistant principal at three district schools, providing parents and students an opportunity to meet and ask questions of final candidates for the positions.
ADVISORY COUNCILS
VOLUNTEER
District advisory councils provide input, advice, direction and insight to district leadership on various programs and initiatives in EPS. Membership typically includes parents, community representatives, teachers and staff who serve a designated term on a council. A call for applicants to fill council vacancies is held each spring.
There is a place for everyone who wants to donate their time to supporting students, teachers, projects, events, programs and more. We have varying times and days, long term projects and short sprints, one-on-one opportunities with students or general classroom support, all age groups and grade levels. There is a volunteer opportunity that will meet your availability and interests. Visit www.edinaschools.org/volunteer to learn more.
SURVEYS, FOCUS GROUPS & ONLINE ENGAGEMENT Periodically, the district asks for stakeholder input via surveys, focus groups and online engagement sessions. For example, each spring, staff and families are asked to participate in an annual satisfaction survey, data from which informs site and district improvement plans. Such engagement opportunities are done in accordance with district policy (Policy 520) and research best practices.
BECOME A VOLUNTEER Edina Public Schools is committed to using volunteers to promote and strengthen partnerships between the school and the community as well as to help personalize instruction and enrich curriculum for all learners. Volunteering is a hallmark of Edina and in the 2016-17 school year, additional volunteer opportunities have been created to meet the evolving needs of students. Volunteer opportunities are available in the morning, afternoon, after school, or on weekends. In addition to benefiting students, volunteering in EPS provides personal satisfaction, improved self-esteem, a sense of accomplishment, opportunities to learn, a greater knowledge/understanding of the EPS school system, and work experience.
VOLUNTEER OPPORTUNITIES • Classroom support in all grade levels (e.g. reading, math, writing, science, art) • One-on-one support • Non-academic support • Media Center support
• After school homework support • Before and after school Success Center support • Saturday School • And more!
GET STARTED TODAY! Complete a volunteer application and the Edina Volunteer Program will match your skills and interests with available volunteer opportunities. Appropriate preparation and training will be provided prior to starting your volunteer experience. We are committed to working with you to ensure volunteering is a rewarding experience for everyone. Thank you for your interest in volunteering with Edina Public Schools!
By volunteering at the Edina Community Center I have not only helped kids excel to be their best, but I also have had an extreme amount of self-satisfaction in giving back to my community. - Ravneet Anand, EHS sophomore
LEARN MORE AND APPLY AT EDINASCHOOLS.ORG/VOLUNTEER
The Edina Resource Center listens to your needs and connects you to the resources that can help. A partnership of Edina Community Education Services, Edina Public Schools and the City of Edina, the Edina Resource Center is your connection to community resources and information in Edina. We are free and confidential. MAKE US YOUR FIRST CALL FOR RESOURCES SUCH AS: • • • • • • • • • • • • •
Chemical and mental health City and community information Childcare Chore services Education (early childhood to adult) Energy, food and housing assistance Family and individual supports Financial resources and tax assistance Health care supports Immigrant services Legal/mediation services Transportation And more
Contact 952-848-3936 or visit www.edinaresourcecenter.com to get connected.
SIGN UP FOR OUR E-NEWSLETTER! Sign up for the Edina Resource Center Newsletter to receive seasonal notifications, updates on community resources, upcoming events and more. To sign up, email
contact@ edinaresourcecenter.com
or call 952-848-3936.
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*** Open Houses/Get Connected Days Check your school for more info 15 School Board Meeting, 7 p.m. 15-18 Edina Learning Institute 29 First Day of School (Gr. 1-12) 30 First Day of School (Edina Family Center, ECSE, Kindergarten)
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PCN Forum, EPAC 7 p.m. EHS Fall Choral Concert, 7 p.m. 20-21 Education MN Conf. - No School 24 School Board Meeting,7 p.m. 25 EHS Fall Band Concert, 7 p.m. 29 EHS Carnival Concert, 6 p.m.
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2016 OCTOBER
Please visit www.edinaschools.org/calendar for details and a complete list of events.
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14 National Merit Reception, 6 p.m. School Board Meeting, 7 p.m. PCN Forum, EPAC, 7 p.m. *** Fall Conferences 23-25 Thanksgiving Break - No School
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See specifi cs
Dates vary per school
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First/Last Day of School
Early Release
No School
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No School 20 Teacher Data - No School 24 EHS Pajama Concert, 6 p.m. 30 School Board Meeting, 7 p.m. PCN Forum, EPAC, 7 p.m.
EMERGENCY SCHOOL CLOSINGS All unscheduled school closings, late starts and early dismissals due to severe weather, extreme cold or heat, or other emergencies, will be shared with families through the district’s messaging system (SchoolMessenger), the district’s website (edinaschools.org), district social media accounts, and through local news media. Families are encouraged to have alternate plans in place for possible emergency school closings. In accordance with district policy, decisions to cancel or shorten the regular school day are made by the superintendent or his designee, in consultation with other staff. Consultation may also include City of Edina personnel and neighboring school districts, as appropriate. The most compelling reason for closing schools involves the safety of students and employees. Decisions about schools closings and late starts will be made as early as possible, either the night before or as early in the morning as possible.
Emergency notifications: • • • • • • •
Automated voicemail Email Text message District and school websites Social media (Facebook and Twitter) Radio: WCCO 830-AM Television: WCCO Ch. 4, KSTP Ch. 5, FOX 9 KMSP, and KARE 11
Unscheduled delayed starts
In the event of a delayed start, the following programs are cancelled: • Edina High School’s Zero Hour • Morning ECSE • Family Center programs • Some Community Education programs may also be cancelled
Evening cancellations
Decisions to cancel after-school and evening activities will be made by 3 p.m. if possible and are not necessarily tied to a school closing. LEARN MORE AT EDINASCHOOLS.ORG/ EMERGENCYCLOSINGS
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2016-17 EARLY RELEASE DAYS Early release days were introduced in the 2013-14 school year to provide critical collaboration time that allows teachers to better customize learning experiences for each student. Scheduling early release days throughout the school year provides teachers with time to analyze student achievement data, collaborate with colleagues and align their instruction for maximum student learning. On early release days, schools dismiss two hours earlier than their regularly scheduled time. During the 2016-17 school year there are four early release days that apply to all K-12 students:
• Friday, Sept. 30
• Thursday, March 23
• Wednesday, Dec. 7
• Tuesday, May 2
Note: Families of EHS students should consult the high school calendar for additional early release or late start days pertaining to testing and special programs.
Will there be busing on these days? Yes! District transportation will adjust for the two hour early release, meaning that on those dates the bus will drop off students two hours earlier than usual. Are Family Center, Early Childhood and Early Childhood Special Education classes affected by early release days? Edina Family Center classes that end after 12 p.m. on early release days will be cancelled. Early Childhood Special Education classes or home visits that begin after 12:30 p.m. will also be cancelled on scheduled early release days.
ENRICHMENT OPPORTUNITIES
Edina Community Education Services (CES) invites students to participate in enrichment programs on early release days. CES collaborates with EPS classroom teachers to offer activities that complement what students are learning during the school day. Elementary Program – Elementary students can enroll in enrichment programs at their home elementary school for any or all of the early release days. • Cost: The cost per student for each two-hour time block is $20. To learn more about scholarships for the CES enrichment program, please call 952-848-3952. • Registration: Interested families can register for enrichment programs at Edina. thatscommunityed.com School-age care programs – Current participants in KIDS Club, WISE Guys and SURGE will receive information about early release day options with your registration packets. These dates will be offered as additional registration choices.
COMMUNITY EDUCATION EDINA COMMUNITY Education
Edina Community Education is an integral part of Edina Public Schools, extending the work of our shared mission and vision beyond the traditional K-12 school day. Community Education programs and services build skills, promote health and well-being, support families, and develop learning
EARLY EDUCATION The Edina Family Center offers high-quality early education programs for families with children from birth through age five. Programs include New Baby and Me classes, Early Childhood Family Education (ECFE), preschool, child care and more. For more information, call 952-848-3908.
Thank you for all you do to help little ones have such a positive first school experience. The combination of my child learning and me learning at the same time is wonderful for families.�
YOUTH PROGRAMS Youth Programs offer a variety of fun and educational activities for ages 3-18. KIDS Club (gr. K-3) WISE Guys (gr. 4-5) and SURGE (gr. 6-9) provide high quality, out-of-school time care. Youth Enrichment offers opportunities before and after school, and on many school release days. For more information, call 952-848-3952.
My grandson had so much fun. He had a chance to connect with classmates from his school and tapped on his creativity and technology skills.
ADULT EDUCATION We offer lifelong learning, including Adult Basic Education and English Language Learning, fitness, global awareness, technology, professional development and experiential community events, to help adults thrive and stay engaged in our modern, evolving community.
This class was beyond expectations. My skills have gone from minimal to quite good, I am motivated to keep learning, and I am having a great time meeting others!
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APPLICATION FOR EDUCATIONAL BENEFITS HOW TO COMPLETE THE APPLICATION FOR EDUCATIONAL BENEFITS Complete the Application for Educational Benefits form for school year 2016-17 if any of the following applies to your household: • Any household member currently participates in the Minnesota Family Investment Program (MFIP), or the Supplemental Nutrition Assistance Program (SNAP), or the Food Distribution Program on Indian Reservations (FDPIR). or • The household includes one or more foster children (a welfare agency or court has legal responsibility for the child). or • The total income of household members is within the guidelines shown below (gross earnings before deductions, not take-home pay). Do not include as income: foster care payments, federal education benefits, MFIP payments, or value of assistance received from SNAP, WIC, or FDPIR. Military: Do not include combat pay or assistance from the Military Privatized Housing Initiative. The income guidelines are effective from July 1, 2016 through June 30, 2017. MAXIMUM TOTAL INCOME:
Household Size
$ Per Year
$ Per Month
1 2 3 4 5 6 7 8 Add for each additional person
21,978 29,637 37,296 44,995 52,614 60,273 67,951 75,647
1,832 2,470 3,108 3,747 4,385 5,023 5,663 6,304
$ Twice Per Month 918 1,235 1,554 1,874 2,193 2,512 2,832 3,152
7,696
642
321
$ Per 2 Weeks
$ Per Week
846 1,140 1,435 1,730 2,024 2,319 2,614 2,910
423 570 718 865 1,012 1,160 1,307 1,455
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Step 1 Children List all infants and children in the household, their birthdate and, if applicable, their grade and school. Attach an additional page if needed to list all children. Fill in the circle if a child is in foster care (a welfare agency or court has legal responsibility for the child). Please provide the requested information on ethnicity and race for each child. This information is not required and does not affect approval for school meal benefits. The information helps to make sure we are meeting civil rights requirements and fully serving our community. Step 2 Case Number Circle Yes or No to show whether any household member currently participates in any of the three assistance programs listed in Step 2. If you answer Yes, write in the case number and go to Step 4 (skip Step 3). If you answer No, continue on to Step 3. WIC and Medical Assistance (M.A.) do not qualify for this purpose.
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Step 3 Adults / Incomes / Last 4 Digits of Social Security Number • List all adults living in the household (everyone not listed in Step 1) whether related or not, such as grandparents, other relatives, or friends. Include any adult who is temporarily away from home, like a student away at college. Attach another page if necessary. • List gross incomes before deductions, not take-home pay. Do not list an hourly wage rate. For adults with no income to report, enter a ‘0’ or leave the section blank. This is your certification (promise) that there is no income to report for these adults. • For each income, fill in a circle to show how often the income is received: each week, every other week, twice per month, or monthly. • For farm or self-employment income only, list the net income per year or month after business expenses. A loss from farm or self-employment must be listed as 0 income and does not reduce other income. • Last four digits of Social Security number – The adult household member signing the application must provide the last four digits of their Social Security number or check the box if they do not have a Social Security number. • Regular incomes to children – If any children in the household have regular income, such as SSI or part-time jobs, list the total amount of regular incomes received by all children. Return your completed application to: Food & Nutrition Services Do not include occasional earnings like babysitting or lawn mowing. Edina High School 6754 Valley View Road Step 4 Signature and Contact Information An adult household member must sign the form. If you do not want your information to be shared with Minnesota Health Care Programs, Edina, MN 55439 check the “Don’t share” box in Step 4.
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STUDENT INFORMATION RELEASE NOTE TO PARENTS This is an “opt out” form for the 2016-17 school year. Complete this form only if you DO NOT want your student’s name, photograph, or directory information to be included in school directories, yearbooks, on school and district websites, or news releases. You do not need to submit this form if you have no objection to your student’s information and photograph potentially appearing in internal and external publications. LIMITATION ON DISTRICT RELEASE OF STUDENT INFORMATION Edina Public Schools recognizes its responsibilities in regard to the collection, maintenance and dissemination of students’ educational records and data. District Policy 515 defines the procedures and practices for protecting the privacy of student information in accordance with state and federal law. Completion of this form is to prohibit the release of student directory information. STUDENT DIRECTORY INFORMATION Directory information regarding a student is public information under state and federal law. Directory information as defined in District Policy 515 includes, but is not limited to, a student’s name, address, telephone number, email address, photograph, date and place of birth, attendance dates, grade level, participation in activities and sports, degrees and awards received, and weight/height of athletic team participants. It also includes the name, address and telephone number of the student’s parent(s). A parent/guardian may refuse to have any or all of the directory information made public by notifying the building principal in writing by Wednesday, Sept. 28, 2016 or 30 days after enrollment in Edina Pubic Schools. Submission of the bottom of this form to the building principal satisfies this notice requirement. PHOTOGRAPHY As noted above, a student’s photograph/image/recording is also directory information and may be released. A student may be photographed or recorded while at school or participating in school activities and events. Care is taken to ensure that the student and learning/activity/event environment is portrayed appropriately. If you choose not to have your child photographed or recorded by the district, please notify the building principal in writing by Wednesday, Sept. 28, 2016. Submission of the bottom of this form to the building principal satisfies this notice requirement. In accordance with District Policy 515, the above-noted designations or refusals will remain valid until the end of the 2016-17 school year. If you have any additional questions please contact your building principal.
I, as parent/guardian of the below named student(s), elect that the district is not able to disclose directory information for the 2016-17 school year. (Please select one of the following choices.)
A B
The district may not release any directory information regarding the child(ren) listed below. This election includes the non-release of photographs/images/recordings. The district may not release any photographs/images/recordings of the child(ren), but may release directory information regarding the child. Child’s name: _______________________________
School:________________
Grade: ____
Select: oA oB
Child’s name: _______________________________
School:________________
Grade: ____
Select: oA oB
Child’s name: _______________________________
School:________________
Grade: ____
Select: oA oB
Child’s name: _______________________________
School:________________
Grade: ____
Select: oA oB
Parent/Guardian name (please print): ______________________________________ Parent/Guardian signature: ______________________________________________
Date:________________
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Does your child have health insurance? If not, it may be available
Call Hennepin County Human Services and Public Health Department at 612-596-8500
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Student Immunization Form Student Name _________________________________________________ Birthdate _____________________Student Number __________________ Minnesota law requires children enrolled in school to be immunized against certain diseases or file a legal medical or conscientious exemption.
FOR SCHOOL USE ONLY ( ) Complete; booster required in ___________ ( ) In process; 8 mos. expires _____________ ( ) Medical exemption for _________________ ( ) Conscientious objection for _____________ ( ) Parental/guardian consent _____________
Parent/Guardian: You may attach a copy of the child’s immunization history to this form OR enter the MONTH, DAY, and YEAR for all vaccines your child received. Enter MED to indicate vaccines that are medically contraindicated including a history of disease, or laboratory evidence of immunity and CO for vaccines that are contrary to parent or guardian’s conscientiously held beliefs. Sign or obtain appropriate signatures on reverse. Complete section 1A or 1B to certify immunization status and section 2A to document medical exemptions (including a history of varicella disease) and 2B to document a conscientious exemption. Additionally, if a parent or guardian would like to give permission to the school to share their child’s immunization record with Minnesota’s immunization information system, they may sign section 3 (optional). For updated copies of your child’s vaccination history, talk to your doctor or call the Minnesota Immunization Information Connection (MIIC) at 651-201-5503 or 800-657-3970. School Personnel: Be sure to initial and date any new information that you add to this form after the parent/guardian submits it. Also, record combination vaccines (e.g., DTaP+HepB+IPV, Hib+HepB) in each applicable space.
1st Dose 2nd Dose 3rd Dose 4th Dose 5th Dose Mo/Day/Yr Mo/Day/Yr Mo/Day/Yr Mo/Day/Yr Mo/Day/Yr Required (The shaded boxes indicate doses that are not routinely given; however, if your child has received them, please write the date in the shaded box.) Type of Vaccine
DO NOT USE () or ()
Diphtheria, Tetanus, and Pertussis (DTaP, DTP, DT) • for children age 6 years and younger • final dose on or after age 4 years Tetanus and Diphtheria (Td) • for children age 7 years and older • 3 doses of Td required for children not up to date with DTaP, DTP, or DT series above
5th dose not required if 4rd dose was given on or after the 4th birthday
Tetanus, Diphtheria and Pertussis (Tdap) • for children in 7th - 12th grade Polio (IPV, OPV) • final dose on or after age 4 years
4th dose not required if 3rd dose was given on or after the 4th birthday
Measles, Mumps, and Rubella (MMR) • minimum age: on or after 1st birthday Hepatitis B (hep B) Varicella (chickenpox) • minimum age: on or after 1st birthday • vaccine or disease history required Meningococcal (MCV, MPSV) • for children in 7th - 12th grade • booster given at age 16 years
Recommended Human Papillomavirus (HPV) Hepatitis A (hep A) Influenza (annually for children 6 months and older)
Additional exemptions: • Children 7 years of age and older: A history of 3 doses of DTaP/DTP/DT/Td/Tdap and 3 doses of polio vaccine meets the minimum requirements of the law. • Students in grades 7-12: A Tdap at age 11 years or later is required for students in grades 7-12. If a child received Tdap at age 7-10 years another dose is not needed at age 11-12 years. However, if it was only a Td, a Tdap dose at age 11-12 years is required. • Students 11-15 years of age: A 3rd dose of hepatitis B vaccine is not required for students who provide documentation of the alternative 2-dose schedule. • Students 18 years of age or older: Do not need polio vaccine. Developed by the Minnesota Department of Health - Immunization Program
www.health.state.mn.us/immunize
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Student Name _______________________________________________
Instructions, please complete: Box 1 to certify the child’s immunization status Box 2 to file an exemption (medical or concientious) Box 3 to provide consent to share immunization information (optional)
1. Certify Immunization Status. Complete A or B to indicate child’s immunization status. A. Received all required immunizations:
I certify that this student has received all immunizations required by law.
Signature of Parent / Guardian OR Physician / Public Clinic _______________ Date
B. Will complete required immunizations within the next 8 months: I certify that this student has received at least one dose of vaccine for diphtheria, tetanus, and pertussis (if age-appropriate), polio, hepatitis B, varicella, measles, mumps, and rubella and will complete his/her diphtheria, tetanus, pertussis, hepatitis B, and/or polio vaccine series within the next 8 months. The dates on which the remaining doses are to be given are:
Signature of Physician / Public Clinic _______________ Date
2. Exemptions to School Immunization Law. Complete A and/or B to indicate type of exemption. A. Medical exemption: No student is required to receive an immunization if they have a medical contraindication, history of disease, or laboratory evidence of immunity. For a student to receive a medical exemption, a physician, nurse practitioner, or physician assistant must sign this statement: I certify the immunization(s) listed below are contraindicated for medical reasons, laboratory evidence of immunity, or that adequate immunity exists due to a history of disease that was laboratory confirmed (for varicella disease see * below). List exempted immunization(s):
B. Conscientious exemption: No student is required to have an immunization that is contrary to the conscientiously held beliefs of his/ her parent or guardian. However, not following vaccine recommendations may endanger the health or life of the student or others they come in contact with. In a disease outbreak schools may exclude children who are not vaccinated in order to protect them and others. To receive an exemption to vaccination, a parent or legal guardian must complete and sign the following statement and have it notarized: I certify by notarization that it is contrary to my conscientiously held beliefs for my child to receive the following vaccine(s):
Signature of physician/nurse practitioner/physician assistant _______________ Date *History of varicella disease only. In the case of varicella disease, it was medically diagnosed or adequately described to me by the parent to indicate past varicella infection in ___________ (year) Signature of physician/nurse practitioner/physician assistant (If disease occured before September 2010, a parent can sign.)
Signature of parent or legal guardian _______________ Date Subscribed and sworn to before me this: _______ day of ______________________ 20______ Signature of notary
3. Parental/Guardian Consent to Share Immunization Information (optional):
Your child’s school is asking your permission to share your child’s immunization documentation with MIIC, Minnesota’s immunization information system, to help better protect students from disease and allow easier access for you to retrieve your child’s immunization record. You are not required to sign this consent; it is voluntary. In addition, all the information you provide is legally classified as private data and can only be released to those legally authorized to receive it under Minnesota law. I agree to allow school personnel to share my student’s immunization documentation with Minnesota’s immunization information system:
Signature of parent or legal guardian Developed by the Minnesota Department of Health - Immunization Program
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Date www.health.state.mn.us/immunize
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