Littleton Public Schools Exhibit

Policy Code    JK-E-3 Policy Name Student Discipline

If this is revised, also revise b\eforms\jk-e-3.

New Student Enrollment

Parent Verification of Student’s Standing at Prior School

By signature below, I am verifying that the following information provided to the school at the time of my child’s enrollment is, to the best of my knowledge, complete and truthful. I understand that my child is being enrolled in this school on the condition that I provide truthful information. I further understand that my child may be withdrawn from enrollment if any of the information I have provided proves to be false.

Behavior [check one]

     My child has not been expelled from any school district in the past 12 months, and my child has not engaged in behavior in another school in the past 12 months that was detrimental to the welfare or safety of other students or of school personnel.

     My child has been expelled from a school district in the past 12 months or my child has engaged in behavior in another school in the past 12 months that was detrimental to the welfare or safety of other students or of school personnel (if the latter, attach a written explanation of the circumstances of the negative behavior).

Residence [check one] (See Policy Subcodes JFA)

     I verify that the child and I live at the address given on enrollment forms, which is an address within the Littleton Public Schools boundaries.

     Other

Guardianship [check one] (See Policy JFAA)

     I verify that I have legal guardianship of the child (if relevant, attach power of attorney).

     Other

Special Education Status [check one]

     My child was receiving or staffed to receive special education services at his/her most recent educational placement.

     My child was not receiving or staffed to receive special education services at his/her most recent educational placement.

Criminal Charges—Students Ages 14 –17 [check one]

     My child has not been charged with any offense constituting a crime of violence.

     My child was charged on ______________________ with the following offense:

  in    

                                       (Crime of Violence)                                                   (County)

Student’s Complete Legal Name:

Date of Birth:

Signature of Parent/Guardian/Legal Custodian:

Date: