HS Student Forms

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 forms, please follow the link below.

Louisiana Student Application
School
Junction City School Student Information Sheet
Parent/Guardian Email (not required)
example@example.com
Student First Name:*
Student Middle Name:*
Student Last Name:*
Grade:*
Enrollment Option:
Birth Date:*

MonthDayYear
Date
Who does the student Live with? (Use drop down to select)*
Name of Primary Guardian (Or person filling this form)*
Mailing Address of parent or legal guardian: (This is where school will mail any info)*
Primary Contact Information:
Primary contact home number:*
Name of primary contact:*
Primary contact cell number:*
Name of primary contact cell number:*
Mother's Contact info
Mother's Name:
Mother's Employer
Mother's Cell number:
Mother's Work Number:
Mother's Address if different than main address:
Father's Contact info
Father's Name:
Father's Employer
Father's cell number:
Father's Work Number:
Father's address if different from main address:
Emergency Contacts:
1. Name:*
Phone Number:*
Can this person pick your student up from school?*

YesNo
2. Name*
Phone Number:*
Can this person pick your student up from school?*

YesNo
Name and grades of siblings attending JCSD
1. Sibling Name
Grade:
2. Sibling Name
Grade:
3. Sibling Name
Grade:
Is this student a military dependent and residing in the household of a person who is on active duty or serving in the reserve component of a branch of the United States Armed Forces?*

YesNo
If Yes, Please specify:*
Has any of the above information changed since last school year?*

YesNo

Parent Acknowledgement of Handbook Policies
HS 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

OBJECTION TO PUBLICATION OF DIRECTORY INFORMATION

(Not to be filed if the parent/student has no objection)
I, the undersigned, being a parent of a student, or a student eighteen (18) years of age or older, hereby note my objection to the disclosure or publication by the Junction City School District of directory information, as defined in Policy No. 2.2 (Privacy of Students’ Records), concerning the student named below. I understand that the participation by the below-named student in any interscholastic activity, including athletics and school clubs, may make the publication of some directory information unavoidable, and the publication of such information in other forms, such as telephone directories, church directories, etc., is not within the control of the District. I understand that this form must be filed with the office of the appropriate building principal within ten (10) school days from the beginning of the current school year or the date the student is enrolled for school in order for the District to be bound by this objection. Failure to file this form within that time is a specific grant of permission to publish such information.
I object and wish to deny the disclosure or publication of directory information as follows:

Deny disclosure to military recruitersDeny disclosure to Institutions of postsecondary educationDeny disclosure to Potential employersDeny disclosure to all public and school sources. Selecting this option will prohibit the release of directory information to the three categories listed above along with all other public sources (such as newspapers), AND result in the student’s directory information not being included in the school’s yearbook and other school publications.Deny disclosure to all public sources. Selecting this option will prohibit the release of directory information to the first three categories listed above along with all other public sources (such as newspapers), but permit the student’s directory information to be included in the school’s yearbook and other school publications.
Student Name:*
Signature of parent (or student, if 18 or older) (Use your mouse to sign)

Clear

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:
Student Signature:*

Clear
Parent Signature:*

Clear
Date*

MonthDayYear
Date

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 Email:
Parent/Guardian Signature:*

Clear
Date*

MonthDayYear
Date

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

Parent Involvement Survey
Junction City High School is dedicated to student success and parent involvement. Regular PTO (Parent Teacher Organization) meetings are scheduled to bring parents, teachers and other members of the community together in order to strengthen our ability to help our students. Please check the schools website (www.junctioncity.k12.ar.us) regularly for dates and topics of these meetings.

Below is a survey to help the school bring in guest and find resources to best help your specific needs
I would like to hear a guest speaker on the following topic(s.)
I need help with Senior topics such as getting into college, financial aid, and scholarships.
I can help present on the following topics.
I would like to participate in the parent involvement committee.

YesNo
I plan to attend PTO meetings

YesNo
Parent/Guardian Name   Parent/Guardian Name

Students attending Junction City Schools:
Name: Grade:
Name 1    Grade
Name 2    Grade
Name 3   Grade
Name 4   Grade

Contact Information:
Phone Number(s)  Phone Number

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

JCHS Attendance policy

Please read attendence policy below.
Student Signature:

Clear
Parent Signature:

Clear
Date

MonthDayYear
Date

JCHS Student Cell phone policy

Please read cell phone policy below.
Student Signature:

Clear
Parent Signature:

Clear
Date

MonthDayYear
Date

JCHS Dress Code Policy

Please read the dress code policy below.
Student Signature:

Clear
Parent Signature:

Clear
Date

MonthDayYear
Date

VIRTUAL ARKANSAS AUDIO VISUAL RELEASE Form
This Audio Visual release and Memorandum of Understanding must be signed and returned in to the facilitator within the first 10 days of entering a Virtual Arkansas course. This release will be maintained by the local school
Please select the following that applies to your child:

By checking the box to the left, I am authorizing Virtual Arkansas to use audio and/or visual representations of mychild/legal dependent in class recordings, publications, websites, video presentations or any other electronic or ·published media, to promote or communicate the advancement of Virtual Arkansas digital courses.By checking the box to the left, I am not authorizing Virtual Arkansas to use audio and/or visual representations of my child/legal dependent in any way, as described above. However, I DO give permission for my child to participate in the interactive Zoom sessions.
Parents: Please sign below to indicate that you have read and understand the Virtual Arkansas Student Handbook:
Parent/Guardian Name:*
Parent/Guardian Signature:*

Clear
Date*

MonthDayYear
Date
Parent/Guardian Phone Number:*

Area CodePhone Number

Virtual Arkansas Student Memorandum of Understanding:
1. It is my responsibility to familiarize myself and abide by all Virtual Arkansas policies as outlined in the handbook. The Student Handbook may be accessed via this link: Virtual Arkansas Handbook
2. I will maintain appropriate classroom behavior as outlined by my high school handbook, the Virtual Arkansas
  
  Student Handbook, and my digital learning teacher classroom procedures.
3. I will be accountable for all ,class activities, including online and offline instruction.
4. I will be respectful to all digital learning teachers, facilitators, and other students participating in class.
5. I will actively participate in my digital learning experience.
6. I will not willingly participate in activities that are dishonest, including, but not limited to, cheating and plagiarism.
7. I will follow the computer usage guidelines of my local school district, my digital learning teacher, and make every
  
  effort to attend the interactive sessions.
8. I will make my digital learning class a priority and r:nake every effort to access th~ course content daily.
9. I will take the respcmsibility to obtain and complete missed assignments when I am absent.
10. I understand that I may be removed from a Virtual Arkansas class and receive a W, F, or no grade, if 1 am involved in a severe discipline or academic dishonesty incident.
Student Name:*
Signature*

Clear
Date*

MonthDayYear
Date
School District:

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
Students Name:*
Do you have internet access at home?*
What type of internet do you have?*
How is your internet performance*
If you do not have internet, what is the reason?*
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

Parent Acknowledgement of Handbook Policies

OBJECTION TO PUBLICATION OF DIRECTORY INFORMATION

STUDENT ELECTRONIC DEVICE and INTERNET USE AGREEMENT

Google Apps for Education Permission Form:

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

Parent/Legal Guardian Media Recording Release for Students

Drug Testing for Extracurricular Activities and Driving on Campus

SIGNED STATEMENT RECEIPT OF THE Parent Involvement Plan and Compact

Parent Involvement Survey

JCHS Automated Message Board (Thrillshare)

Names and numbers to receive text messages from JC Schools?

JCHS Attendance policy

JCHS Student Cell phone policy

JCHS Dress Code Policy

VIRTUAL ARKANSAS AUDIO VISUAL RELEASE Form

Virtual Arkansas Student Memorandum of Understanding:

Dragon Virtual School Handout Policy

Junction City School District/Northeast Claiborne Charter School

Student Agreement

Parent Agreement

Digital Equity Survey Required by the state