Elem Student Packet

Please choose which Ready for Learning option your student will be using.*
You have selected the Low Tech option, although we are required to offer this option, this is the worst route to take and should only be selected if you have no internet at home. If you stay with this option, your child's principle will contact you to discuss the choice with you to make sure it fits.
For Louisiana student application, please follow the link below.

Louisiana Student Application
NECC
JCSD
School
Junction City School Student Information Sheet
Parent/Guardian Email
example@example.com
Student First Name:*
Student Middle Name:*
Student Last Name:*
Grade:*
Race:*
Home Room Teacher:*
Birth Date:*

MonthDayYear
Date
Primary Contact Information:
Name of primary guardian: (Person filling this form)*
Primary contact phone number:*
Name of primary contact cell number:*
Mailing Address of parent or legal guardian: (This is where school will mail any info)*
Mother's Contact info
Mother's Name:
Mother's Home Phone Number:
Mother's Cell number:
Mother's Work Number:
Mother's Physical address:
Mother's mailing address:
Father's Contact info
Father's Name:
Father's Home Phone Number:
Father's cell number:
Father's Work Number:
Father's physical address:
Father's mailing address if different from main address:
Emergency Contacts:
1. Name:*
Phone Number:*
2. Name*
Phone Number:*
3. Name*
Phone Number:*
Name and grades of siblings attending JCSD
1. Sibling Name
Grade:
2. Sibling Name
Grade:
3. Sibling Name
Grade:
Name and grades of siblings attending JCSD
Transportation

Car RiderBus Rider
Medical
Medical Problems if applicable:
Medications:
Side Effects:

Corporal Punishment Form
Dear Parent/Guardian:

The ultimate responsibility for student conduct rests with the student and his/her parents. It is the daily responsibility of school personnel to assure that no student interferes with the learning environment of other students. We will not tolerate any behavior that prevents teachers from teaching or other students from learning, nor will we tolerate any activities that would adversely affect the safety and well-being of the school population.

Please refer to the student handbook, section 4, to review the student conduct not permitted. We will let students know what we expect of them and what consequences they have earned.

If corporal punishment is administered, it will be administered according to the procedures in the handbook.

Refusal to take corporal punishment may result in suspension or other disciplinary measures.
Corporal Punishment*

Corporal punishment may be administered on my child according to the procedures Outlined in the 2020-2021 Elementary Student Handbook.I object to the use of corporal punishment on my child.
Student's Name:*
Home Room Teacher:
Date*

MonthDayYear
Date
Parent/Guardian's Name:*

STUDENT ELECTRONIC DEVICE and INTERNET USE AGREEMENT
Students Name:*
School:
Grade
Today's Date*

MonthDayYear
Date
Please read and review the student internet use agreement below:
Students Signature:*

Clear
Date*

MonthDayYear
Date
Parent's Signature:*

Clear
Date*

MonthDayYear
Date

Google Apps for Education Permission Form:

Please read the following form carefully!
PLEASE MAKE SURE THAT YOU READ THIS CAREFULLY. IF you check NO. your child can not use a Chromebook or Google Classroom which is a requirement in most classes!

By signing below, I confirm that I have read and understand the following:
- Under FERPA and corresponding Arkansas law, a student's education records are protected from
  disclosure to third parties. I understand that my student's education files/records stored in
  Google Apps for Education may be accessible to someone other than my student and the Junction
  City School District by virtue of this on line environment. My signature below confirms my consent
  to allow my student's education files/records to be stored by Google.
- I understand that by participating in Google Apps for Education, information about my child will
  be collected and stored electronically. I have read the privacy policies association with use of
  Google Apps for Education (http://www.google.com/a/help/intl/en/edu/privacy.html. I
  understand that I may ask for my child's account to be removed at any time.
Select one of the following:*

YES, I give permission for my child to be assigned a full Junction City School District Google Apps for Education Account. This means my child will receive an email account and have access to Google Docs, Calendar, and Sites.NO, I don't give permission for my child to be assigned a Junction City School District Google Apps for Education Account. This means my child will NOT receive an email account or access to Google Docs, Calendar, and Sites.
PLEASE understand that by selecting NO, your student can not participate in day to day use of Chromebooks, and other Google products that are a major part of the education that JCSD provides.
Student name:
Grade:
Teacher:
Student Signature:*

Clear
Parent Signature:*

Clear
Date*

MonthDayYear
Date

Parent Acknowledgement of Handbook Policies
Elem Handbook
I have reviewed the JCSD Handbook above, and downloaded for my records. I acknowledge that the Junction City School Board approved these policies for the administration to carry out and agree that my child will abide by these policies while he/ she is a student in the Junction City School District.
Student's Name
Parent/Guardian Signature*

Clear
Student's Signature:*

Clear
Grade:
Date*

MonthDayYear
Date

JCSD Illness letter

Please read the following letter and sign below in acknowledgement
Student's Name
Grade
Teacher
Parent/Guardian Signature:

Clear

Online Publication of Student Pictures Junction City School District Parental Release Form
Your permission is requested in order to publish your child’s picture on our school website.

YES, I give permission for my child’s picture to be posted on the school website. NO STUDENT NAMES WILL BE USED AT ANYTIME! NO, I do not give permission. I do not want my child’s picture to appear on the school web site.*
Parent/Guardian Signature:*

Clear

Parent/Legal Guardian Media Recording Release for Students
I hereby grant permission to the Arkansas Department of Education (ADE) to use the above-named student's photo, video, and likeness for promotional purposes by the ADE in all manners, including, but not limited to: news releases, photographs, video, audio, website, and other electronic or printed published media. I agree that these images and/or voice recordings may be used for a variety of purposes without further notifying me. I understand the ADE shall not use any of the student’s personally identifying information, except for the student's first name, the school that he/she attends, and the student’s grade, without first obtaining my express permission. The ADE has my permission for this use until I submit written revocation of my permission to the ADE Communications Office at Four Capital Mall, Room 404-A, Little Rock, AR 72201, ADE.Communications@Arkansas.gov, or you may call 501-682-2155. I understand the ADE does not have control over a third party who retrieves my student’s information published by the ADE and uses it without my permission. I agree to hold the ADE harmless for such misuse of my student's information.
Parent/Guardian Name:*
Student's Name:
Parent/Guardian Name:
Parent/Guardian Signature:*

Clear
Date*

MonthDayYear
Date

Permission form for all Elementary Field Trips.
Child's Name
Teacher's Name
I give my permission for my child to go on field trips planned at Junction City Elementary School
Parent/Guardian Signature:

Clear

SIGNED STATEMENT RECEIPT OF THE Parent Involvement Plan and Compact
The Junction City High School annually provides for a signed statement by the parent(s) that they have received and reviewed a copy of the High School Parental Involvement Plan and Compact.

“I have received and reviewed the Junction City Parental Involvement Plan and Compact. I understand that I am expected to be an active participant in my child’s education.”
Student's Name:
Grade
Parent/Guardian Signature:*

Clear
Date*

MonthDayYear
Date

JCHS Automated Message Board (Thrillshare)
Student Name:
Grade:
Names and numbers to receive text messages from JC Schools?
Name:*
Phone Number*

Area CodePhone Number
Name:
Phone Number

Area CodePhone Number
Name:
Phone Number

Area CodePhone Number

ARKANSAS MINIMUM GRADUATION REQUIREMENTS SMART CORE WAIVER FORM

Please review the following form and keep for your records.
Please choose the option that applies to your child:*

I have reviewed the form and saved for my records.

Dragon Virtual School Handout Policy
Regardless of the enrollment option you have chosen, you must be familar with the Dragon Virtual School policy in the even that JCSD/NECC must shut down and move to a virutal only educational experience. Please review the policy and save for your records.
DVS Policy review*

I acknowledge that I have read and reviewed the Dragon Virtual School policy and have saved for my records.

Junction City School District/Northeast Claiborne Charter School

Academic Integrity Agreement
Please read the following carefully:
A Core Value

Academic Integrity is one of our core values and one of the most important areas of focus as a learning organization. Students with academic integrity make decisions based on ethics and values that will prepare them to be productive and ethical citizens.

Proctored Exams

All students sign the 'I Agree' page during course registration in which the student agrees to abide by the policies and procedures of DVS. Included in DVS policies is the administration of proctored exams. Proctored exams can be requested by DVS at any time and for any reason in an effort to ensure academic integrity. It is the student’s responsibility to work cooperatively with DVS faculty to schedule and take the exam. When taking the exam to assess a student’s integrity, the exam must be passed with at least a 59.5%. DVS may institute a program to regularly administer proctored exams to randomly selected students.

Discussion Based Assessments (DBAs)

Each teacher regularly conducts discussion based assessments with his or her students. These conversations occur at specific intervals as well as randomly in a course and are included in the assessment component of each course. The teacher discusses individual student work and extends the conversation to allow the student to demonstrate mastery of the content and to verify the authenticity of the student’s work. Students are required to complete and pass all discussion based assessments themselves, free from any distraction or influence of others.

“I Agree” Statement

By clicking the "I Agree" button at the bottom of this page, I agree to submit 100% of my own work, and I commit to Academic Integrity by registering as a student at Dragon Virtual School (DVS). By clicking the "I Agree" button, I also agree to take a proctored exam at any time if requested. I understand that I may be required to have a web camera in order to complete this process. I also understand that should I finish the segment in an extremely accelerated pace, I may be subject to additional accountability measures. Failure to comply with the Academic Integrity commitment or refusing to take a proctored exam will be grounds for removal from the DVS program. Further, I agree to comply with all of the policies and procedures listed in the DVS Code of Conduct/Student Handbook.

I hereby assign to DVS all right, title and interest in and to all the material I submit to DVS in conjunction with any course(s) I take with DVS. All personally identifying information provided
to DVS will be maintained in compliance with the Family Educational Rights and Privacy Act of 1974 (FERPA) and other applicable privacy laws.

Commercial Use of Academic Material:

Selling course material to another person, student, entity, and/or uploading to a third-party vendor without the express written permission of DVS is prohibited. Course materials include, but are not limited to, class notes, instructor's power points, course syllabi, tests, quizzes, labs, instruction sheets, homework, study guides, and handouts.
By clicking this box, I agree to abide by the Junction City School District/Northeast Claiborne Charter School Academic Integrity Agreement.

I agree
Student Agreement
Student Name:*
Student's Signature:*

Clear
Date*

MonthDayYear
Date
Parent Agreement
Parent/Guardian Name*
Parent/Guardian Signature:*

Clear
Date*

MonthDayYear
Date

Digital Equity Survey Required by the State of Arkansas
Students Name:
Do you have internet access at home?
What type of internet access do you have?
How is your internet Performance
If you do not have internet, what is the reason?
If you do not have internet, what is the reason?*

Not AffordableNot AvailableNot ApplicableOther
Forms complete, please click submit!
Should be Empty:

Junction City School Student Information Sheet

Primary Contact Information:

Mother's Contact info

Father's Contact info

Emergency Contacts:

Name and grades of siblings attending JCSD

Name and grades of siblings attending JCSD

Medical

Corporal Punishment Form

STUDENT ELECTRONIC DEVICE and INTERNET USE AGREEMENT

Google Apps for Education Permission Form:

Parent Acknowledgement of Handbook Policies

JCSD Illness letter

Online Publication of Student Pictures Junction City School District Parental Release Form

Parent/Legal Guardian Media Recording Release for Students

Permission form for all Elementary Field Trips.

SIGNED STATEMENT RECEIPT OF THE Parent Involvement Plan and Compact

JCHS Automated Message Board (Thrillshare)

Names and numbers to receive text messages from JC Schools?

ARKANSAS MINIMUM GRADUATION REQUIREMENTS SMART CORE WAIVER FORM

Dragon Virtual School Handout Policy

Junction City School District/Northeast Claiborne Charter School

Student Agreement

Parent Agreement

Digital Equity Survey Required by the State of Arkansas

Forms complete, please click submit!