NOTE: Under AB216, if you checked any of the above, you may be eligible to graduate by completing the minimum state requirements. For eligibility determination, please see your academic counselor for additional information.
In case of accident or other emergency, if parent or guardian cannot be reached, I hereby authorize a representative of the school to make arrangements considered necessary for my student to receive medical or hospital care, including necessary transportation. Under such circumstances, I further authorize the physician named below to undertake such acts and treatment of my student, as he/she considers necessary. In the event said doctor is not available, I authorize care and treatment to be performed by any licensed physician or surgeon.
The undersigned hereby agree to bear all costs incurred as a result of the forgoing. This authorization will remain in effect until revoked by the undersigned in writing.
The information provided below will help the LEA determine what services you and/or your child may be eligible to receive. This could include additional educational services through Title I, Part A and/or the federal McKinney-Vento Assistance Act. The information provided on this form will be kept confidential and only shared with appropriate school district and site staff.
Your child or children may have the right to:
If you have any questions about these rights, please contact the local homeless liaison, Tizoc Brenes, by phone at 213-741-2600 or by email at firstname.lastname@example.org.
School Counseling Services
This letter is intended to inform and request your consent for your student to receive counseling services at our school site. As part of our structured and coherent counseling program, students may be referred to, or request, counseling services. These services are provided at no cost. However, these services are not intended as a substitute for diagnosis or treatment for any mental health disorder. The MSW interns along with a licensed clinician will provide assistance through case management, one-on-one counseling, crisis intervention, behavioral counseling, group counseling, and workshops. If a need for treatment beyond the scope of services provided on site arises, you will be contacted to consent for such services. The intent is to provide support for yourself or your son/daughter, the school, and your family. The MSW interns at YCSC are available to address the wellness needs of all students. Your student may choose to visit the MSW interns to confidentially speak with them. During the process of providing these services all other information exchanged will be kept confidential.
We have an ethical obligation to maintain student’s confidentiality to facilitate the appropriate support for your student in a school setting. Whenever possible and in the best interest of your student the MSW intern/counselor will encourage and seek permission from your student to share information and conversations with their parents/guardians. Exceptions to confidentiality exist to protect the emotional and physical safety of your student.
Exceptions to confidentiality in a school setting:
The MSW interns work on a team with school staff and YouthBuild affiliated partners. Therefore, they need to notify faculty/staff of the working relationship between the MSW intern and student. The information shared will include attendance and recommendations to enhance the student’s academic progress. No other specific information regarding sessions will be provided to the school/partner staff unless verbal/written consent is given by the student to do so.
Notice to Parent/Guardian regarding Consent
Pursuant to Family Code 6920-6926 and Health Code 124260, in certain situations, students 12 years or older may consent to counseling services on their own behalf. Including parent/guardian in a student’s services are a priority of YCSC. We recognize that in most cases, parent involvement yields greater outcomes for students and when appropriate the staff will strongly encourage parent involvement in services.
My signature below indicates that I have been notified about YouthBuild Charter School of California’s mental health counseling services, informed consent and the limits to confidentiality.
BBS Notice to Clients
The Board of Behavioral Sciences receives and responds to complaints regarding services provided within the scope of practice of (marriage and family therapists, licensed educational psychologists, clinical social workers, or professional clinical counselors). You may contact the board online at www.bbs.ca.gov , or by calling (916) 574-7830.
Overview of the Assembly Bill 167/216
AB167/216: (California Education Code §§51225.1 and 51225.2) applies to students in foster care or involved with the juvenile justice system and transfer to a new school after completing their 2nd year of high school.
Eligibility of the AB 167/216
AB 167/216: The student must be identified as a foster as defined below:
Overview of the Assembly Bill 1806 & 490
AB 1806: Became effective on January 1, 2015 (California Education Code §§51225.1 and 51225.2). It extended the same rights to those experiencing homelessness and transferred to a new school after completing their 2nd year of high school.
AB 490: Allows schools to issue full or partial credit for coursework satisfactorily completed at a previous school.
Eligibility of the Assembly Bill 167/216
AB 1806 & AB 490: A student identified as homeless as defined below.
a.) The McKinney-Vento Act defines homeless children and youth as individuals who lack a fixed, regular, and adequate nighttime residence. This definition also includes Children and youth sharing the housingof other persons due to loss of housing, economic hardship, or a similar reason. b.) The student residency questionnaire provides more details on students who qualify as homeless and must be completed annually.
Other criteria factored in:
c.) A student with an open foster care/juvenile court case or identified as a homeless transfer. d.) The student could not complete the additional district graduation requirements within 4 total years of high school enrollment.
YouthBuild Charter School of California (YCSC) is committed to providing a working and learning environment free from discrimination, harassment, intimidation, abusive conduct or bullying. YCSC prohibits discrimination, harassment, intimidation, abusive conduct or bullying based on actual or perceived race or ethnicity, gender/sex (including gender identity, gender expression, pregnancy, childbirth, breastfeeding/lactation status and related medical conditions), sexual orientation, religion, color, national origin (including language use restrictions and possession of a driver’s license issued under Vehicle Code), ancestry, immigration status, medical information, physical or mental disability (including clinical depression and bipolar disorder, HIV/AIDS, hepatitis, epilepsy, seizure disorder, diabetes, multiple sclerosis, and heart disease), medical condition (cancer related and genetic characteristics), military and veteran status, parenting status, marital status, registered domestic partner status, age (40 and above), genetic information, political belief or affiliation (unless union related), a person's association with a person or group with one or more of these actual or perceived characteristics, or any other basis protected by federal, state or local law, ordinance, or regulation in any program or activity it conducts or to which it provides significant assistance.
Discrimination is different treatment on the basis of a protected characteristic in the context of an educational program, work or activity without a legitimate nondiscriminatory reason that interferes with or limits the individual’s ability to participate in or benefit from the services, activities, or privileges provided by YCSC or includes an adverse employment action.
Hostile environment harassment occurs when a target is subjected to unwelcome conduct on the basis of a protected characteristic, which is both subjectively offensive to the target and would be offensive to a reasonable person of the protected characteristics under similar circumstances, and is sufficiently severe, persistent, or pervasive so as to interfere with or limit an individual’s ability to effectively work or to participate in or benefit from the services, activities or opportunities offered by YCSC. Harassment may take many forms, including but not limited to, verbal remarks and name calling, graphic and written statements, or any conduct that may be threatening or humiliating. Harassment based on any of the above-protected categories is a form of unlawful discrimination and will not be tolerated by YCSC and can result in disciplinary action against the offending student or employee.
Upon witnessing an act of discrimination, harassment, intimidation, abusive conduct or bullying based on actual or perceived protected characteristics, school personnel are required to take immediate steps to intervene when it is safe to do so. Once a school/office has express notice or reason to know of such conduct, whether carried out by employees, students or third parties, it should take immediate and appropriate steps to investigate or otherwise determine what occurred and take prompt and effective steps reasonably calculated to end the conduct, eliminate a hostile environment, if one has been created and prevent the conduct from occurring again. These steps should be taken regardless of whether an individual makes a complaint or asks the school/office to take action. Complainants are protected from retaliation. YCSC prohibits retaliation against any person who files a complaint or an appeal, reports instances of noncompliance, discrimination, harassment, intimidation, abusive conduct or bullying, or who participates in the complaint-filing or investigation process. This nondiscrimination policy applies to all acts related to school activity or school attendance within any school/office under the jurisdiction of the Superintendent of YouthBuild Charter School of California.
For inquiries or complaints related to discrimination, harassment, intimidation or bullying of students based on actual or perceived protected characteristics, contact the Title IX/Bullying Complaint Manager:
Dr. Rudy Cuevas 155 W. Washington Blvd. Suite 944 Los Angeles, CA 90015 213.741.2600. ext. 205
For inquiries or complaints related to employee-to-employee, student-to-employee, or work/employment related discrimination, harassment, abusive conduct or intimidation, contact your Human Resources Department.