Communities In Schools (‘CIS’) of Ohio is an affiliate of the national Communities In Schools network, the nation’s leading provider of Integrated Student Supports with the mission to surround students with a community of support, empowering them to stay in school and achieve in life. By signing this consent, I give permission for my child to participate in the academic and non-academic support services and enrichment programs connected by CIS of Ohio provided in schools, the community, and through online, virtual meetings and other remote supports as applicable. These services may include, but are not limited to:
- Supportive Guidance, Educational Support, Surveys/Assessments, Social-Emotional Learning (SEL) Support
- Tutoring, Mentoring, Enrichment Activities
- Linkage to resources, services, and non-academic barrier reduction
- Remote and online supports such as: academic, enrichment, and SEL resources; resource referrals; and additional supports as applicable
- Referrals and connections to other agencies and community supports
I understand that the data and information collected is securely maintained and the information is used by CIS of Ohio to document services provided to students and families for tracking and reporting purposes. I also understand that CIS of Ohio may use the information to update service information, provide closure and follow-up information, and evaluate and determine the effectiveness of the program. All information is confidential and will be requested only as needed to provide services and resources.
I hereby grant permission for my child's school and school district to share my child's academic, attendance, behavior, and/or other applicable records for the current, prior and future school years with Communities In schools of Ohio so that CIS can provide services to my child and understand the impact of this program. I understand that information will only be shared about my child if it is relevant to my child's education and well-being. I understand that this information will be kept confidential. I understand I am able to revoke the consent at any time in writing.
The data collected may include, but is not limited to the following: a) Enrollment b) Attendance c) Behavior/Discipline Records d) Demographic Information e) Grade Reports, Test Scores, Transcripts, Assessment Information/Results and other Educational Records f) Surveys and/or interviews about his/her knowledge, attitudes or skills.
I understand that this information will remain confidential, and that only approved partners of CIS of Ohio will be able to access/review this data. All employees are expected to adhere to any applicable laws, regulations and professional Code of Ethics as it relates to confidentiality of information.
I acknowlege that I have the right to inspect and obtain a copy of any reocrd released by this consent by making the request to CIS in writing, subject to any applicable legal limitations.
By signing this consent form, I also grant permission for CIS of Ohio to photograph, film, video and/or make sound recordings and quotes, or publish statements of my child for educational, promotional and advertising materials and purposes. |