www.chisagolakes.k12.mn.us

Chisago Lakes School DistrictStudent & Parent Handbook

2016-2017(updates will be made as needed - Updated 11/18/16)

Chisago Lakes School District #214413750 Lake Blvd.Lindstrom, MN 55045

651-213-2000www.chisagolakes.k12.mn.us

Adopted by the School Board on September 15, 2016

Important InformatIon

please read &

Keep for future reference

CL District Student & Parent Handbook - Page 2Go on-line www.chisagolakes.k12.mn.us to view complete District Policies

Student and Parent Handbook2016-2017 School Year

Welcome to Chisago Lakes Area School District 2144!

It is our goal to provide all students with a solid educational experience, opportunities to grow intellectually, emotionally, and socially, all while keeping them safe.

This handbook is intended to provide general information as well as the district’s policies and procedures.

Please take time to review these policies and keep this publication handy as a reference tool throughout the year. Feel free to call your child’s school office or our district office if you have questions or need clarification on any of these expectations.

Disclaimer: All policies are in effect at the time this document was printed. Policies can be changed at any time by a school board decision or legislative mandate. Up to date policies can be found on our website: www.chisagolakes.k12.mn.us

CL District Student & Parent Handbook - Page 3Go on-line www.chisagolakes.k12.mn.us to view complete District Policies

Chisago Lakes Primary School11009 284th Street, Chisago City, MN 55013Grades K-2Principal Brenda SchellPhone Number 651-213-2200Office Hours 7:30 am - 4:00 pmSchool Hours 9:15 am - 3:40 pm

Lakeside Elementary School10345 Wyoming Ave, Chisago City, MN 55013Grades 3-5Principal Sara JohnsonPhone Number 651-213-2300Office Hours 7:30 am - 4:00 pmSchool Hours 9:05 am - 3:30 pm

Taylors Falls Elementary School648 West Street, Taylors Falls, MN 55084Grades K-5Principal Jason RiebePhone Number 651-213-2100Office Hours 7:30 am - 4:00 pmSchool Hours 9:05 am - 3:35 pm

Chisago Lakes Middle School13750 Lake Blvd., Lindstrom, MN 55045Grades 6-8Principal Jodi OtteAssoc. Principal Jim GillachPhone Number 651-213-2400Office Hours 7:00 am - 3:30 pmSchool Hours 7:40 am - 2:20 pm

Chisago Lakes High School29400 Olinda Trail, Lindstrom, MN 55045Grades 9-12Principal Dave ErtlAssoc. Principal Carrie HoffmanPhone Number 651-213-2500Office Hours 7:00 am - 4:00 pmSchool Hours 7:50 am - 2:30 pm

Chisago Lakes Education CenterFairview Medical Center11685 Lake Blvd., Chisago City, MN 55013Program Director Karen MortensonPhone Number 651-213-2071 (Pathway To Change and SOAR) 651-213-8063 (Fairview Treatment)Office Hours 7:00 am - 3:00 pmSchool Hours 8:00 am - 2:00 pm

District Office13750 Lake Blvd., Lindstrom, MN 55045Phone Number 651-213-2000Office Hours 7:00 am - 3:30 pmSuperintendent Joe ThimmDir. of Business Services Heide MillerDir. of Curriculum & Communication Sarah SchmidtUnique Learners Manager Nicole JackDir. of Buildings & Grounds Steve Mikutowski

Athletic / Activities Department29400 Olinda Trail, Lindstrom, MN 55045Activities Director Neil FletcherPhone Number 651-213-2526Office Hours 7:00 am - 3:00 pm Community Education13289 St. Croix Ave, Lindstrom, MN 55045Director Robert MeyerPhone Number 651-213-2600Office Hours 8:00 am - 4:00 pm

Early Childhood / Family Center13289 St. Croix Ave, Lindstrom, MN 55045Coordinator Carmen WoeltgePhone Number 651-213-2600Office Hours 8:00 am - 4:00 pm

Early Childhood Special Ed.13750 Lake Blvd., Lindstrom, MN 55045Coordinator Melanie SteverPhone Number 651-213-2494 Food Service13750 Lake Blvd., Lindstrom, MN 55045Director Kathy Burrill Phone Number 651-213-2506Office Hours 7:00 am - 3:30 pm

4.O Chisago Lakes Bus Service13450 Newlander Ave, Lindstrom, MN 55045Manager Liz LunzerPhone Number 651-213-2020Office Hours 6:00 am - 5:00 pm

Pool29400 Olinda Trail, Lindstrom, MN 55045Director Ellen HeathDirector’s Phone Number 651-213-2604Pool Number 651-213-2585

St. Croix River Education DistrictPO Box 637, Rush City, MN 55069Executive Director of Special Ed. Jamie NordDir. of Special Ed. Nicole WoodwardPhone Number 651-674-2436

Chisago Lakes General Information & Directory

CL District Student & Parent Handbook - Page 4Go on-line www.chisagolakes.k12.mn.us to view complete District Policies

Chisago Lakes School District Student & Parent Handbook

Accident InsuranceWe wish to emphasize that the school district does not provide any type of health or accident insurance for injuries incurred by your child at school. We encourage parents to review their present policies to determine if coverage is adequate. Accident insurance is available to parents through Gerber Life Insurance Company. Information is available on the school website under Parents > Student Voluntary Insurance. For more information on Gerber Life Insurance Company, go to their website at https://www.k12specialmarkets.com.

ActivitiesChisago Lakes School District offers a far-ranging variety of extra-curricular activities in both fine arts and athletics. Students in grades 7-12 are encouraged to participate. Fees will be charged for all activities and must be paid during the first week of practice. Special consideration will be given to those students financially unable to pay. Students may participate in one sport per season. Prorated refunds will be issued when a student must resign from an activity due to cutting, a medical condition, or transfer. There are no refunds for rules violations or arbitrary resignations. There is a limit of three (3) fees per student per year.

High School Fee Schedule Middle School Fee ScheduleAll Sports (except hockey) $ 185.00 Middle School Sports $ 110.00Hockey $ 285.00 Middle School Play $ 55.00Cheerleading $ 185.00Powerlifting $ 90.00Fine Arts $ 90.00

Attendance / Address ChangesStudents are to be in attendance each day in which school is in session. Please notify the school about any changes in address or phone numbers immediately. If a student is absent from school, a parent must call the school to inform us of the reason for the absence. If you know in advance your child will not be in school, pre-excused absence forms are required and are available in the school office or online. Each school has its own attendance clerk and telephone number for parents to call. A note from parents is also expected on the day the student returns.

Taylors Falls Elementary Attendance / Address Changes 651-213-2100 Primary School Attendance / Address Changes 651-213-2200 Lakeside Elementary Attendance / Address Changes 651-213-2300 Middle School Attendance 651-213-2411 Middle School Address Changes 651-213-2404 High School Attendance / Address Changes 651-213-2513 Pathway to Change / SOAR 651-213-2071 Fairview Recovery 651-213-8063

Students are expected to make up work missed.

Unexcused absences are considered truancy, whether for a whole day or any part of it. Consequences of truancy may include a parent conference, in-school suspension, referral to Chisago County, or loss of credits. (Policy 503) Repeated incidents of truancy will be reported to truancy intervention personnel. Individual building procedures regarding attendance may differ. Parents and students should refer to their building handbooks.

CL District Student & Parent Handbook - Page 5Go on-line www.chisagolakes.k12.mn.us to view complete District Policies

Available Services:

Chemical Health ServicesChemical Health services promote healthy lifestyles through classroom presentation and support through the district’s health curriculum. Prevention efforts and intervention services are addressed through support programs such as D.A.R.E, Project Charlie, and S.A.D.D. provided by Lakes Area Police School Resource Officers.

Counseling ServicesA counselor, dean, or school psychologist is available at all of our schools to work with students relating to their intellectual, physical, emotional, and social development. They provide a channel of communication where students can express their concerns about academics, friendships, feelings about themselves, and family.

Media CentersThe Chisago Lakes School District provides a media center in each building for student use. The books and other media are borrowed property and deserve the respect of the borrower. Each media center has its own rules and behavior expectations and it is the student’s responsibility to know and respect both.

Use of School BuildingsThe Chisago Lakes School District Community Education Office is responsible for scheduling all buildings and athletic facilities, etc. used by interested parties. Groups should contact Community Education at 651-213-2603.

Cancellation of SchoolCancellation of school takes place only during circumstances such as extreme weather, equipment failure or public crisis. The School Board and administration are aware of the hardship that can be caused by an abrupt cancellation. Announcements for school cancellation or late start will be made on WCCO radio AM 830, Channel 4 TV, Channel 5 TV, Channel 9 TV, and Channel 11 TV. You will also be notified by an automated calling system. This system uses your phone and e-mail information from Synergy, the district’s student information system.

Community EducationCommunity Education is part of the Chisago Lakes School District #2144. Program information, schedules, and registration forms can be found on the Community Education link on our district web-site (www.chisagolakes.k12.mn.us.)

Community Education offers a variety of programs, including:

• Adult Basic Education and General Education Development• Adult Enrichment and Recreation Classes and Leagues• Community Chorus - Unexpected Company• Computer Courses and Online Classes• Parenting Classes Early Childhood Family Education and Little Wildcats Preschool• Early Childhood Screening and Special Education Support Services• Toy and Book Lending Library• Facility Use Scheduling for Non School Hours• School Age Child Care Services (Kid’s Club) • School Readiness• Summer Trips, Sports Camps and Classes• Youth Enrichment• Youth Recreation• Youth Development• Driver Education

CL District Student & Parent Handbook - Page 6Go on-line www.chisagolakes.k12.mn.us to view complete District Policies

Community Education School-Age Childcare ProgramCommunity Education sponsors a reliable before and after school child care program for PreK-5th graders at each of our elementary buildings. Our program offers quality child care in an environment that is safe, nurturing, enriching, and fun. Kid’s Club is offered on days when school is not in session and during the summer months for PreK-5th graders. For fees and application forms, contact Kid’s Club at 651-213-2600.

Consent to Release Educational InformationThe school will maintain records on all students. Information included in these records may not be released without written parental consent except for directory information (public data). See Data Privacy policy 515 in the policy section.

Credit Card PaymentsFamilies now have the option to pay student activity fees online with a credit card. Go to the “Online Registration Instructions” on the Activities page of the school’s website for payment instructions.

Distribution of Materials by Non-School PersonsNon-school persons and organizations may distribute, at reasonable times and places as set forth in the school policy, and in a reasonable manner, materials and objects which are appropriate to the school setting. Requests for distribution of materials will be reviewed by the administration on a case-by-case basis. Distribution of certain materials is prohibited. If permission is granted pursuant to the policy for distribution of materials, the time, place and manner of distribution will be solely within the discretion of the administration, consistent with the provisions of this policy. (Policy 904)

Electronic CommunicationIn an effort to save money and our environmental resources, communications will be sent electronically. Items would include emailing documents OR a link to documents on our website, such as the student handbook, newsletters, building communications, etc. We are utilizing our database and will be asking parents/guardians to update email information at orientation/open houses, for the coming year. There is an option to let us know if you would like to receive a paper copy.

Emergency DrillsClassrooms have posted procedures for fire, tornado and lockdown emergency drills. Five fire drills, one tornado drill and five lockdown drills will be conducted during the school year to ensure each student knows what to do in each situation.

Emergency InformationParents are asked to update their student(s) emergency contact information each Fall (and as needed throughout the school year) via the ParentVUE parent access internet site. This can also be completed at the August student orientation/open house nights. Parents are asked to provide home/work/cell phone numbers for themselves and for friends, neighbors or relatives listed as local emergency contacts. Please inform these individuals that you are listing them as emergency contacts.

Parents should also report any student health conditions that impact the school day directly to the school health office and/or school nurse so that an appropriate plan of care can be developed. Parents are not legally required to provide health and emergency data, however, school staff will not be able to respond thoroughly and safely without current information. All private information will be handled in accordance to School District policy as well as State and Federal laws.

CL District Student & Parent Handbook - Page 7Go on-line www.chisagolakes.k12.mn.us to view complete District Policies

Fines for Lost or Damaged BooksStudents who lose or damage textbooks, workbooks, library books, etc. will be charged the replacement cost of the item. A letter or email will be sent to the parents either when the book is reported lost or damaged or at the end of the grading term or school year indicating the amount that is owed if the book is damaged or not returned.

Food & Nutrition Services Program / Prices / NotesAccountsEach student is assigned a universal Personal Identification Number (PIN) to be used to access their individual meal account. The PIN is used when depositing monies on the account, purchasing a meal, second entrée and milk or ala carte items. A universal PIN means that students will keep the same number the entire time they are enrolled in Chisago Lakes Schools and can be used at any building in the district.

Students may purchase one (1) reimbursable Breakfast at a cost of $1.50 for full paid students and no charge for approved free and reduced price and ALL kindergarten students. Student lunch price at the elementary schools is $2.35 and $2.55 at the secondary schools for full paid students. A second lunch will be charged at $3.65 at both elementary and secondary buildings.

Parents and siblings are invited to eat lunch with their child at school anytime throughout the school year. Please call the elementary school kitchen in the morning to “make reservations”, if possible. The cost for a breakfast is $2.00 for adults. The cost of an adult lunch is $3.65. The cost for breakfast for a pre-kindergarten sibling is $1.75 and $2.50 for lunch.

For security purposes and to meet federal and state guidelines, students are not permitted to use another student’s account. The computer records and tracks balances. Balances remain in accounts and follow the student from year-to-year and building-to-building.

Low Balances and ChargingCashiers will provide a verbal notice at the cash register when the balance is low. (A stamp on the hand may be offered to students). Households will be notified by phone via an automated calling system when a student’s balance is low. The complete policy regarding charging meals is available on the district website located under Department Information on the Food Services page.

Prepayment for MealsIt is preferred that one check be written for each student’s lunch account. However, if more than one child in a family attends the same school, one check may be written. Please place in an envelope and indicate the child’s full name and PIN on the check. Indicate the amount that goes into each account.

If you have students in several buildings and prefer to write one check for all students, you may send a check to the District Food Service Office at 13750 Lake Blvd., Lindstrom, MN 55045, and indicate the students PIN and the amount that goes into each account.

If you would like to make an electronic payment, please visit PayPams at www.paypams.com. This system will allow you to pre-pay with a credit card, PayPal account or debit from your checking account. It also allows you to access meal account activity and balance information online. There is a $1.95 fee charged per transation. Call the Food Service office at 651-213-2025 with questions regarding this service. Also, PayPams has an app for your smartphone. It is currently available for both Android and Apple devices.

CL District Student & Parent Handbook - Page 8Go on-line www.chisagolakes.k12.mn.us to view complete District Policies

Free/Reduced Price Meal BenefitsFamilies must complete a new application each school year. An application form has been attached at the end of this handbook. A completed application must be sent to the District Office Food Service Department, 13750 Lake Blvd., Lindstrom, MN 55045, or dropped off at the Principal’s office and it will be forwarded to the Food Service office. Benefits may be applied for anytime during the school year. Notification of the status of an application will be mailed.

MenusOur menu is now on a five week cycle and will be distributed for the entire year. Copies will be available at each of the buildings and given to students to take home and post. Menus are also available on the school district’s website. Nutritional analysis information is available on the website as well. Parents will now have the opportunity to see what is on the menu each day of the year, and the nutritional information for each day’s menu. The breakfast menu will be on a weekly cycle with several options available each day. A hot breakfast item will be offered daily. Please keep in mind that menus are subject to change, as need may arise. As a result of new Federal meal regulations, all students are required to have a serving of fruit or vegetable on their tray. We do our very best to offer a wide variety of choices for students. We will use fresh, local produce as much as possible.

Meals• All menus and portions are planned to meet the Meal Pattern Requirements established by USDA.• Our school breakfast program offers students a complete breakfast every morning before school begins.• Our school lunch program is designed to provide one-third of a student’s minimum daily nutritional

requirements.

Fresh fruits and vegetables, and whole grains are offered each day. Lactose reduced milk is offered to students whose parents submit a written request. These requests must be updated each school year. Please contact the Food Service Office at 651-213-2506 if you have any questions regarding special needs diets or with any questions or concerns you have regarding the program.

Food TreatsChisago Lakes School District requires that food, which is served in schools, be commercially prepared and packaged. Therefore, we do not allow the distribution of food items including “treats” which are prepared in individual homes. This does not include food brought to school for a student’s individual snack or lunch.

FundraisingThe school board or their designee has the authority to regulate all fundraising activities in the district. All fundraising activity must have prior approval of a building administrator, Activities Director or the Director of Community Education. The school district expects all students who participate in approved fundraising activities to represent the school, the student organization and the community in a responsible manner. All rules pertaining to student conduct and student discipline extend to student fundraising activities. (Policy 511)

Graduation Ceremony RequirementsIt is the position of the Chisago Lakes School District that the graduation ceremony is an exercise for those seniors who have met the requirements for a diploma. It is also important that students and parents be informed in the event that a student may not qualify to participate in this ceremony. The district will use the following procedures when determining those seniors who will participate in the graduation ceremony.

• All seniors are expected to have 28 of 29 credits in order to participate in the graduation ceremony.• Parents of seniors will be notified during the summer prior to their student’s senior year of the credits required

for graduation in the form of a credit check.

CL District Student & Parent Handbook - Page 9Go on-line www.chisagolakes.k12.mn.us to view complete District Policies

• The high school shall notify parents of those seniors who do not have enough credits to participate and/or graduate as soon as the lack of credits is apparent.

• A letter will be sent at the beginning of Term 3 if a student is credit deficient and in jeopardy of not graduating. If a student becomes credit deficient during Term 3 or Term 4, notification to the parent will be at the time the student becomes deficient.

• Seniors who fail a class at the end of the Term 4 may go through the ceremony if they are one credit short. If they are short more than one credit, they may not participate. Parents and students will be notified by a counselor that they will be pulled from the graduation ceremony at the last moment if they do not have the necessary 28 of 29 credits.

• The Principal/Superintendent may grant exceptions to this practice in cases that are beyond reasonable control of the student (example, prolonged illness or accident).

• Required Minnesota State Tests ► Reading MCA-III, 10th grade ► Math MCA-III, 11th grade ► Science MCA-III, 11th grade

• Students with IEPs who have met district standards for graduation, but will stay in the district’s transition program after their senior year, may participate in the graduation ceremony. The actual awarding of the diploma will be withheld until the student completes the IEP requirements.

• No exceptions will be made for those who receive failing grades due to violations of our attendance policy.

Illness at SchoolA student who becomes ill while at school should go to the health office for evaluation of symptoms. If the student needs to go home, parents or designated emergency contact will be notified.

ImmunizationsState law requires that every public school student (including home-based technology programs) must have either written evidence of the required immunizations or a notarized exemption form on file at school. The required immunizations vary depending on the grade of the student. Refer to the District Website/Health Services/Immunizations tab or contact your school’s Licensed School Nurse for more information on required immunizations.

Insurance Minnesota Health Care Programs have free and low-cost health insurance for children and families who qualify. (Medical Assistance has no monthly premium. MinnesotaCare has a monthly premium based on household income.) Your child may qualify if your household income is within certain guidelines. Income is one factor for qualifying. Other rules and limits apply. For more information, call your county office or visit https://mn.gov/dhs/partners-and-providers/health-care/.

To get a Minnesota Health Care Programs application:• Print one from the Internet: https://edocs.dhs.state.mn.us/lfserver/Public/DHS-3417B-ENG• Call Chisago County at 651-213-5202

Internet Acceptable Use / TechnologyThe Chisago Lakes School District considers the use of electronic information networks like Internet as an educational resource. Proper use of the school district’s Internet access and computer use is the responsibility of the individual user. Misuse of the Internet, computer or equipment may lead to revocation of the employee, student or agent’s Internet access and possible other discipline. The equipment, software, information, communication, processing and storage resources provided by the school district are the sole property of the district. (Policy 524)

CL District Student & Parent Handbook - Page 10Go on-line www.chisagolakes.k12.mn.us to view complete District Policies

The school district supplies computers, internet access and other electronic devices to enhance student’s education. These supports are for educational purposes. Users are reminded that the district monitors all internet use. An individual search of usage, files & flash drives may occur if there is reasonable suspicion of misuse. Users have a limited expectation of privacy in the contents of their personal files, communication files and record of web research. Routine maintenance and monitoring, using both technical monitoring systems and staff monitoring may lead to the discovery that a user has violated district policy or the law. (Policy 524)

Mammals and Other Creatures of Nature in School BuildingsTo ensure the safety of students and community, animals will be allowed in school buildings only with prior approval of building principals or the Community Education Director and in accordance with the Guidelines & Procedures on Animals established by the Board of Education. (Policy 540)

MedicationsThe administration of medication during the school day is provided to enable the student to remain in school, to maintain or improve health status, and to improve his/her potential for learning. If a child needs to take a prescription drug during school hours, parent or guardian are expected to make appropriate arrangements to have necessary medication for the child delivered to the school health office. The medication must be authorized by the parent or guardian, have been prescribed by a physician, and be in a pharmacy labeled container. The parent or guardian must send a permission statement authorizing the use of non-prescription medications. All non-prescription medication must be brought to school in an original labeled container. All prescription and non-prescription medications will be kept in and administered through the school health office for safety reasons. There are exceptions (self-carry option) for asthma inhalers and non-prescription pain medications for grade 7-12 students. Check with the school health office to obtain an agreement from your school nurse. (Policy 516)

Military PersonnelParents and 11th and 12th grade students have the right to refuse release of student’s name, address and home telephone number to military recruiting officers. This process can be completed by contacting the building administrative office or the district office or by using the “Data Privacy Request Form” on page 19 of this handbook.

Minnesota Academic StandardsCurrently, the required K-12 standards are in English, language arts, mathematics, science, social studies, physical education, and the arts. Health, careers and technical education, and world languages each require districts to develop local standards. You can find more information on and view the standards for each subject on the Minnesota Department of Education web-site.

Our district has been working to ensure that our curriculum is aligned with these state standards. Minnesota students are assessed on these standards using the state required Minnesota Comprehensive Assessment – reading for students in grades 3-8 & 10, math for students in grades 3-8 & 11, and science for students in grades 5, 8 and 11.

CL District Student & Parent Handbook - Page 11Go on-line www.chisagolakes.k12.mn.us to view complete District Policies

Open House Schedules and Parent/Teacher Conference Dates

Open House Schedules

Building Date Time

High School 9th Grade Orientation Tuesday, August 30 1:30-5:30 pm 9th Grade Parents & Students Tuesday, August 30 6:15-6:30 pm Grades 9-12 Tuesday, August 30 6:30-8:00 pm

Middle School Grades 6-8 Orientation Monday, August 29 3:00-7:00 pm

Lakeside Grades 3-5 Wednesday, August 31 4:00-6:00 pm Kids Club Wednesday, August 31 4:00-6:00 pm

Primary School Kindergarten, Grades 1-2 Wednesday, August 31 4:00-6:00 pm Little Wildcat Preschool Wednesday, August 31 4:00-6:00 pm Kids Club Wednesday, August 31 3:00-6:00 pm

Taylors Falls Kindergarten Wednesday, August 31 2:00-3:00 pm Grades 1-5 Wednesday, August 31 3:00-6:00 pm Little Wildcat Preschool Wednesday, August 31 2:00-6:00 pm Kids Club Wednesday, August 31 2:00-6:00 pm

Chisago Lakes All Grades Wednesday, August 31 3:00-5:00 pmEducation Center

Community Ed. Ready for kindergarten Classes and Wednesday, August 31 4:00-6:00 pm Early Childhood Family Education

Parent/Teacher Conferences

Building Date Time Building Date Time

LakesidePrimaryTaylors Falls

October 17October 18October 19February 7February 9February 10

4:00 - 8:00 pm4:00 - 8:00 pm8:00 am - 4:00 pm4:00 - 8:00 pm4:00 - 8:00 pm 8:00 am - 4:00 pm

Middle School

November 3November 7November 10March 30April 3April 4

3:00 - 7:00 pm7:15 - 9:45 am3:00 - 7:00 pm3:00 - 7:00 pm7:15 - 9:45 am3:00 - 7:00 pm

Chisago Lakes EducationCenter

October 3February 23

3:00-6:00 pm3:00-6:00 pm High School

October 3December 5February 23May 4

3:00 - 7:00 pm3:00 - 7:00 pm3:00 - 7:00 pm3:00 - 7:00 pm

CL District Student & Parent Handbook - Page 12Go on-line www.chisagolakes.k12.mn.us to view complete District Policies

Parental or Guardian Access to StudentsThe school must receive evidence that a parent or other adult is prohibited from normal or parental rights of access to a child through a legal document as in the case of divorce, separation or custody. Such information must be presented to and discussed with the principal or associate principal.

Personal Devices Usage in School GuidelinesIntroductionChisago Lakes School District provides students access to a wireless network and the option of utilizing a personally owned device as a means to enhance their education. The purpose of this document is to assure that students and their parents recognize the limitations that the School District imposes on their personal devices.

This personally owned devices usage in school guidelines document is a supplement to the District’s Internet, Computer and Equipment Usage Policy (# 524). These guidelines and policies apply to the use of all laptop computers and other mobile Internet devices owned by the district or owned by the students.

General Usage GuidelinesChisago Lakes School District provides the opportunity for students to bring a personally owned device to school to use as an educational tool. The use of these devices will be at the discretion of staff and/or the district administration.

1. Students must comply with all District Policies, including Policy #524 found in the district student handbook.2. Student use of personally owned devices in the classroom will be at the discretion of staff. 3. Student use of a personally owned device must support the instructional activities currently occurring in the

instructional environment.4. Students must turn off and put away a personally owned device when requested by staff. 5. Students should be aware that use of a device could cause distraction for others in the classroom, especially in

regards to audio. Therefore, audio must be muted or headphones used.6. The use of personally owned devices outside of classroom instruction and the locations they are permissible

will be at the discretion of building administration. 7. The School District reserves the right to inspect, at any time, any personally owned device.8. The School District will not be held responsible for any damage that may occur as a result of connecting to

the CL wireless network or any electrical power source.9. The School District will not be held responsible for any physical damage, loss or theft of a personally owned

device.10. The parents/guardians of any student bringing a personal device to school agree to be responsible for and

to reimburse the school district for any damage that their student may cause to the use of the CL wireless network with his/her personally owned device.

11. Students can only connect to CL wireless network while at school. Students are not allowed to use a wired connection or mobile service for Internet or network access. Using the unapproved connections could result in termination of student owned device usage.

12. Students, in any way, may not use any type of software to hack, crack, or gain access to any unapproved wireless network, wired network, or school servers/services. Unapproved use will result in termination of the personal devices program, as well as possible criminal charges.

13. Students may use the CL network for browser access only. Printing and other networked capabilities are not available on the CL network.

14. Chisago Lakes Schools will not provide technical support for personal computing devices.15. During the course of the school year, additional rules regarding the use of personal devices may be added. If

this occurs, any new rule will become a part of these guidelines.

CL District Student & Parent Handbook - Page 13Go on-line www.chisagolakes.k12.mn.us to view complete District Policies

Personal devices are valuable tools that can enhance teaching, learning and communication in our schools. Students have the opportunity and privilege to use personal devices in a manner that promotes learning and communication and at the same time, does not disrupt or compromise the integrity of the school environment.

TECHNOLOGY USE - CONSISTENCY WITH OTHER SCHOOL POLICIES

Use of the school district Internet system; computer system; electronic devices of any kind, used within the district confines, shall be consistent with school district policies and the mission of the school district. (Refer to Policy 524 – Internet, Computer and Equipment Usage; Personal Devices Usage in School Guidelines; and other pertinent district policies as applicable.)

Pesticide Notice to Parents and GuardiansMinnesota state law requires schools that apply pesticides to maintain an estimated schedule of pesticide applications and make the schedule available to parents and guardians for review or copying at each school office. Spraying for pesticides during the 2016-17 school year will be: October 20 or 21, 2016; one of the days within the dates of December 22, 2016 - January 2, 2017; one of the days within the dates of March 13-17, 2017; and one of the days within the dates of June 12-16, 2017. State law requires that you be told that the long-term health effects on children from the application of such pesticides or the class of chemical to which they belong may not be fully understood. If you would like notification prior to applications made on days other than those specified in the estimated schedule (excluding emergency applications), contact Mary Konobeck at 651-213-2007 for a Request for Pesticide Notifcation form requesting pesticide notification.

Pledge of AllegianceThe school board recognizes the need to provide instruction in the proper etiquette, display, and respect of the United States flag. Students in the school district shall recite the pledge of allegiance to the flag of the United States of America one or more times each week. Anyone who does not wish to participate in reciting the pledge of allegiance for any personal reasons may elect not to do so. Students and school personnel must respect another person’s right to make that choice.

School Board InformationMark Leigh, Chairman 651-303-7753 markandkaren@frontiernet.netLori Berg, Vice-Chair 651-462-6815 bergnsfp@frontiernet.net Dani Strenke, Clerk 651-257-8340 rexthedog@frontiernet.net Brenda Carlson, Director 507-380-6282 beaners19@gmail.comJerry Vitalis, Director 651-257-4496 jerry.vitalis@gmail.comThomas Lawlor, Treasurer 651-257-4356 tjlawlor@frontiernet.net

School District Website – www.chisagolakes.k12.mn.usThe school district maintains a website that provides a wide variety of information about the school district for those with access to the internet. The website is updated continually to provide information on district and school programs and activities as well as school board information.

SolicitationStudents and staff are not to be solicited for money unless a project has been approved by the principal.

Student Safety / DisciplineThe school district is committed to promoting healthy relationships and learning environments that are physically and psychologically safe for all members of the school community.

CL District Student & Parent Handbook - Page 14Go on-line www.chisagolakes.k12.mn.us to view complete District Policies

The school board has established a number of policies that cover student safety and discipline:

413 Harassment and Violence The school district strives to maintain a learning and working environment that is free from religious, racial or sexual harassment and violence. The school district prohibits any form of religious, racial, or sexual harassment and violence.

418 Drug-Free Workplace/Drug-Free Schools Students are prohibited from using alcohol, toxic and/or controlled substances.

419 Tobacco-Free Environment Use of tobacco products is prohibited in school buildings, vehicles, and on school grounds.

501 Dangerous Weapons in the Schools No student or non-student, including adults and visitors, shall possess, use or distribute a weapon when in a school location except as provided in this policy. The school district will act to enforce this policy and to discipline or take appropriate action against any student, teacher, administrator, school employee, volunteer, or member of the public who violates this policy.

502 Search of Student Lockers, Desks, Personal Possessions and Student’s Person Lockers are provided for student convenience. However, these lockers are the property of the school. Therefore, lockers may be searched based on reasonable suspicion.

504 Student Dress and Appearance The purpose of this policy is to enhance the education of students by establishing expectations of dress and grooming that are related to educational goals and community standards. 506 Student Discipline All students are expected to behave appropriately and to follow school rules.

514 Bullying Prohibition Policy The purpose of this policy is to assist the school district in its goal of preventing and responding to acts of bullying, intimidation, violence, and other similar disruptive behavior.

515 Protection and Privacy of Pupil Records The school will maintain records on all students. Information included in these records may not be released without written parental consent except for directory information (public data). Public data consists of student’s name, current grade level (i.e. 5th, 9th, etc.), extracurricular participation (& height/weight if a member of an athletic team, picture (such as for the yearbook) or video taken and used for public distribution/viewing, and current teacher. Also public (unless parent/guardian “opts-out”) is the release of student’s address and name to the Armed Services as allowable by law. If a parent/guardian wishes to NOT have their student’s data released, please send your written request (or use the “Data Privacy Request Form” on page 19) to: Attn: Superintendent Chisago Lakes ISD #2144 13750 Lake Boulevard Lindstrom, MN 55045

525 Violence Prevention Students are the district’s first priority and they should be protected from physical or emotional harm during school activities, and on school grounds, buses, or field trips while under school district supervision.

526 Hazing Hazing activities of any type are prohibited at all times.

Teacher Qualifications NoticeParents of Students Attending Taylors Falls Elementary School:

CL District Student & Parent Handbook - Page 15Go on-line www.chisagolakes.k12.mn.us to view complete District Policies

Taylors Falls Elementary School is a Title I schools for the 2016-17 school year. Parents of students in Title I schools may request, and Chisago Lakes School District will provide the parents on request, information regarding the qualifications of the student’s classroom teachers, including:

• Whether the teacher has met State qualifications and licensing criteria for the grade levels and subject areas in which the teacher provides instruction.

• Whether the teacher is teaching under emergency or other provisional status through which the State qualification or licensing criteria have been waived.

• The baccalaureate degree major of the teacher and any other graduate certification or degree held by the teacher, and the field of discipline of the certification or degree.

• Whether the child is provided services by paraprofessionals and, if so, their qualifications.

All teachers at Taylors Falls Elementary School are highly qualified and have met all State qualifications and licensing criteria for the grade levels and subject areas they teach. All teachers are fully licensed and no teacher is teaching under a variance or emergency or provisional license.

If additional information is needed, please contact Jason Riebe, Taylors Falls Elementary Principal, at 651-213-2101 or jriebe@isd2144.org, or Heide Miller, Director of Business Services, at 651-213-2010 or heide.miller@isd2144.org.

Transportation Rules4.O Chisago Lakes Bus Service provides transportation for Chisago Lakes students.

• Bus passes issued only in the case of an emergency. Middle School bus passes must be approved by Heide Miller at 651-213-2010 by 1:00 p.m. on the date the pass is requested. Many of the buses are at capacity.

• One pick-up location and one drop-off location ONLY for each student is preferred. They may be different locations.

• Students new to the district or those requesting a change in pick-up or drop-off location will be assigned a bus within 5 days. Parents will have to transport students during that time. School-age childcare for grades K-5 is available until 6 p.m. for a fee if parent transportation is not available.

Bus Stop DeterminationOur district policy states that elementary students (grades K-5) can be allowed to walk one-quarter of a mile and secondary students (grades 6-12) can be allowed to walk one-half of a mile on a public road. All distances are based on public roads only. Kindergartners through twelfth grade students are required to walk to the nearest regular bus stop. Each year, bus stop changes will be made to make our stops more efficient. We choose the safest pickup location for all students within a pickup area.

Rules at the Bus Stop1. Get to the bus stop five minutes before your scheduled pick up time. The school bus will not wait for late

students.2. Respect the property of others while waiting at your bus stop.3. Keep your hands, arms, legs and belongings to yourself.4. Use appropriate language.5. Stay away from the street, road, or highway when waiting for the bus.6. Wait until the bus stops before approaching the bus.7. After getting off the bus, move away from the bus.8. If you must cross the street, always cross in front of the bus where the driver can see you. Wait for the driver

to signal you before crossing the street.9. No fighting, kicking, harassment, intimidation, or horseplay.10. No use of alcohol, tobacco, or drugs.

CL District Student & Parent Handbook - Page 16Go on-line www.chisagolakes.k12.mn.us to view complete District Policies

Rules on the Bus1. Immediately follow the directions of the driver.2. Remain seated while bus is in motion.3. Talk quietly and use appropriate language.4. Keep all parts of your body inside the bus.5. Keep your arms, legs, and belongings to yourself.6. No fighting, harassment, intimidation, or horseplay.7. Do not throw any objects.8. No possession or use of alcohol, tobacco, or drugs.9. Do not bring any weapon, look-alike weapon, or dangerous objects on the school bus.10. Do not damage the school bus.11. Driver has the right to assign seats.

Remember! Always treat others with respect.

ConsequencesConsequences for school bus/bus stop misconduct will apply to all regular routes. Decisions regarding a student’s ability to ride the bus in connection with co-curricular and extra-curricular events (for example, field trips or competitions) will be at the discretion of the building principal or the principal’s designee. Parents or guardians will be notified of any suspension of bus privileges. Bus drivers are encouraged to use a variety of discipline tools available prior to referral to the building principal. See Student Transportation Safety Policy 709 for additional details.

Elementary (Grades K-5)1st Referral: Written warning by the bus driver to the student and the driver to contact the student’s parent or guardian either by telephone or direct contact.2nd Referral: Written warning by the bus driver. The principal will counsel the student and contact the parent or guardian informing them of the situation that has developed with their child.3rd Referral: Written warning by the bus driver. The principal will conference with the parent and student. The student will be suspended from the bus for one to five school days.4th Referral: Written warning by the bus driver. The principal will conference with the parent and student. The student will be suspended from the bus for five to ten school days.5th Referral: Written warning by the bus driver. The principal will conference with the parent and student. The student will be suspended from the bus for 20 school days.6th Referral: Written warning by the bus driver. The principal will conference with the parent and student. The student will be suspended from the bus for a minimum of 60 school days up to a maximum suspension of one school year (169 school days).

The principal may substitute or add to any of the above consequences depending upon the circumstances.

Middle School (Grades 6-8)1st Referral: Written warning by the bus driver. Bus driver contacts parent. Administration meets with student and contacts parent.2nd Referral: Written warning by the bus driver. Administration meets with student and contacts parent.3rd Referral: Three school day suspension from riding the bus. Administration meets with student and contacts parent.4th Referral: The student will be suspended from the bus for a minimum of 60 school days up to a maximum suspension of one school year (169 school days). Administration meets with student and contacts parent.

CL District Student & Parent Handbook - Page 17Go on-line www.chisagolakes.k12.mn.us to view complete District Policies

High School (Grades 9-12)1st Referral: Written warning by the bus driver. Bus driver contacts parent.2nd Referral: Three school day suspension from riding the bus. Associate principal contacts parent.3rd Referral: A minimum of 60 school day suspension from riding the bus up to the maximum of one school year (170 school days). Associate principal contacts parent.

Vandalism / Bus DamageStudents damaging school buses will be responsible for the damages. Failure to pay such damages (or make arrangement to pay) within two weeks may result in the loss of bus privileges until damages are paid. The school district may also pursue other available options.

Criminal ConductIn cases involving criminal conduct (for example, assault, weapons, drug possession, or vandalism), the Superintendent, local law enforcement officials, and the Minnesota Department of Public Safety will be informed.

Other DisciplineBased on the severity of a student’s conduct, more serious consequences may be imposed at any time, depending on the nature of the offense. Consequences such as suspension or expulsion from school may also result from school bus/bus stop misconduct.

Videotaping on School BusesChisago Lakes School District places video cameras randomly on all its school buses. The district believes the transportation of students to and from school is an important function of the school district, and is a privilege and not a right for an eligible student. The behavior of students on the bus is a significant factor in the safety and efficiency of school bus transportation. Student misbehavior increases the potential risks of injury. Therefore, the school district believes that videotaping student passengers on the school bus will encourage good behavior and, as a result, promote safety. The videotape of the actions of student passengers may be used by the school district as evidence in any disciplinary action brought against any student, arising out of the student’s conduct on the bus. (Policy 711)

VolunteersWe are grateful for the assistance provided by volunteers during the school year. Volunteers assist us in several areas; tutoring students, clerical help, field trip supervision and special classroom events. However, your child’s safety is our goal. All volunteers will be required to register on Hall Pass at the beginning of each school year at which time a background check will be conducted. Please check with your child’s teacher and/or building principal if you are interested in volunteering.

Visitor PolicyThe School Board welcomes visits to school buildings and school property by parents and community members provided the visits are consistent with the health, education and safety of students and employees, and are conducted within the procedures and requirements established by the School District. All visitors must report to the school office or main entrance area to check in on Hall Pall and receive a visitor badge that must be displayed when in the building. At the conclusion of the visit, the visitor must return to the school office or main entrance area to check out. (Policy 903)

Web Access for ParentsParents have the opportunity to view current grades, missing assignments, end of term grades, and attendance on their student through ParentVUE, a link on the school website, (www.chisagolakes.k12.mn.us). Notices will be sent home to families in the fall regarding how to access the link as well as password information.

CL District Student & Parent Handbook - Page 18Go on-line www.chisagolakes.k12.mn.us to view complete District Policies

District-wide Misc. Policies & Procedures

A copy of the policies in their entirety and legal references are available at the District Office, or by contacting Jodi Davis at 651-213-2011. Policies are also available on-line the district website at: www.chisagolakes.k12.mn.us or by clicking here to be taken to the policy page.

NOTE: Individual building policies may vary or be more building-specific. Also refer to individual building handbooks.

CL District Student & Parent Handbook - Page 19Go on-line www.chisagolakes.k12.mn.us to view complete District Policies

Data Privacy Request Form - 515F

School Year: ______________

Public data includes: child’s name; grade (i.e. second grade); teacher’s name; height and weight (given only if a member of an athletic team); extracurricular participation; picture or video (used for public distribution or viewing); or name/address released to Military organizations as per law.

If any parent/guardian would object to public data released as mentioned above, please check the appropriate box and send this written request to: Superintendent’s Office Chisago Lakes ISD #2144 13750 Lake Blvd.. Lindstrom, MN 55045 651-213-2000

� CHECK HERE IF YOU DO NOT WANT INFORMATION RELEASED TO MILITARY ORGANIZATIONS.

� CHECK HERE IF YOU DO NOT WANT INFORMATION or PICTURE/PHOTO TO BE IN THE HIGH SCHOOL YEARBOOK.

� CHECK HERE IF YOU DO NOT WANT ANY INFORMATION LISTED UNDER PUBLIC DATA TO BE RELEASED.

� OTHER (or comment):___________________________________________________________________.

Parent/Guardian’s Printed Name: ______________________________________________________________

Address:__________________________________________________________________________________

City / Zip:__________________________________________________Phone:_________________________

Please keep the above information private with regard to the following student(s):

1. Student’s Name: __________________________________________

Current Building: _________________________________________ Current Grade:______________

2. Student’s Name: __________________________________________

Current Building: _________________________________________ Current Grade:______________

3. Student’s Name: __________________________________________

Current Building: _________________________________________ Current Grade:______________

___________________________________________________________ _______________________Signature of Parent/Guardian Date

Please note that this request must be filled out each school year and received by October 15th to be in effect for the current school year. Thank you.

Data Privacy Request Form 515F

CL District Student & Parent Handbook - Page 20Go on-line www.chisagolakes.k12.mn.us to view complete District Policies

 

   

 

Dear Parent/Guardian:

Our schools provide healthy meals each day. Breakfast costs: $1.50. Lunch costs: Elementary $2.35 Secondary $2.55

Your children may qualify for free meals or reduced price school meals. To apply, complete the enclosed Application for Educational Benefits following the instructions. A new application must be submitted each year. Your application also helps our school qualify for education funds and discounts.

State funds help to pay for reduced-price school meals, so all students who are approved for either free or reduced-price school meals will receive school meals at no charge. State funds also help to pay for breakfasts for kindergarten students, so all participating kindergarten students will receive breakfasts at no charge.

Return your completed Application for Educational Benefits to: Chisago Lakes Schools – ISD #2144 Attn: Dept. of Food Service 13750 Lake Blvd Lindstrom, MN 55045

Who can get free school meals? Children in households participating in the Supplemental Nutrition Assistance Program (SNAP), Minnesota Family Investment Program (MFIP) or Food Distribution Program on Indian Reservations (FDPIR), and foster, homeless, migrant and runaway children can get free school meals without reporting household income. Also, children can get free school meals if their household income is within the maximum income shown for their household size on the instructions.

I get WIC or Medical Assistance. Can my children get free meals? Children in households participating in WIC or may be eligible for free meals. Please fill out an application.

May I apply if someone in my household is not a U.S. citizen? Yes. You or your children do not have to be U.S. citizens for your children to qualify for free meals.

Who should I include as household members? Include yourself and all other people living in the household, related or not (such as grandparents, other relatives, or friends).

What if my income is not always the same? List the amount that you normally get. If you normally get overtime, include it, but not if you only get overtime sometimes.

Will the information I give be checked? Yes, and we may also ask you to send written proof.

How will the information I provide be kept? Information you provide on the form, and your child’s approval for school meal benefits, will be protected as private data. For more information see the back page of the Application for Educational Benefits.

If I don’t qualify now, may I apply later? Yes. Please complete an application at any time if your income goes down, your household size goes up, or you start getting SNAP, MFIP or FDPIR benefits.

Please provide the information requested about children’s racial identity and ethnicity, which helps to make sure we are fully serving community. This information is not required for approval of school meal benefits.

If you have any other questions or need help, please call 651-213-2506 or email at: kburrill@isd2144.org

Sincerely,

Kathy Burrill, Director of Food Service

CL District Student & Parent Handbook - Page 21Go on-line www.chisagolakes.k12.mn.us to view complete District Policies

How to Complete the Application for Educational Benefits

Complete the Application for Educational Benefits form for school year 2016-17 if any of the following applies to your household:

Maximum Total IncomeHousehold

Size$ Per Year

$ Per Month

$ Twice Per Month

$ Per 2 Weeks

$ Per Week

1 21,978 1,832 916 846 423 2 29,637 2,470 1,235 1,140 570 3 37,296 3,108 1,554 1,435 718 4 44,955 3,747 1,874 1,730 865 5 52,614 4,385 2,193 2,024 1,012 6 60,273 5,023 2,512 2,319 1,160 7 67,951 5,663 2,832 2,614 1,307 8 75,647 6,304 3,152 2,910 1,455

Add for each additional

person 7,696 642 321 296 148

Step 1 ChildrenList all infants and children in the household, their birthdate and, if applicable, their grade and school. Attach an additional page if needed to list all children. Fill in the circle if a child is in foster care (a welfare agency or court has legal responsibility for the child). Please provide the requested information on ethnicity and race for each child. This information is not required and does not affect approval for school meal benefits. The information helps to make sure we are meeting civil rights requirements and fully serving our community.

Step 2 Case Number Circle Yes or No to show whether any household member currently participates in any of the three assistance programs listed in Step 2. If you answer Yes, write in the case number and go to Step 4 (skip Step 3). If you answer No, continue on to Step 3. WIC and Medical Assistance (M.A.) do not qualify for this purpose.

Step 3 Adults / Incomes / Last 4 Digits of Social Security Number List all adults living in the household (everyone not listed in Step 1) whether related or not, such as

grandparents, other relatives, or friends. Include any adult who is temporarily away from home, like a student away at college. Attach another page if necessary.

List gross incomes before deductions, not take-home pay. Do not list an hourly wage rate. For adults with no income to report, enter a ‘0’ or leave the section blank. This is your certification (promise) that there is no income to report for these adults.

For each income, fill in a circle to show how often the income is received: each week, every other week, twice per month, or monthly.

For farm or self-employment income only, list the net income per year or month after business expenses. A loss from farm or self-employment must be listed as 0 income and does not reduce other income.

Last four digits of Social Security number – The adult household member signing the application must provide the last four digits of their Social Security number or check the box if they do not have a Social Security number.

Regular incomes to children – If any children in the household have regular income, such as SSI or part-time jobs, list the total amount of regular incomes received by all children. Do not include occasional earnings like babysitting or lawn mowing.

Step 4 Signature and Contact Information An adult household member must sign the form. If you do not want your information to be shared with Minnesota Health Care Programs, check the “Don’t share” box in Step 4.

Any household member currently participates in the Minnesota Family Investment Program (MFIP), or the Supplemental Nutrition Assistance Program (SNAP), or the Food Distribution Program on Indian Reservations (FDPIR). or

The household includes one or more foster children (a welfare agency or court has legal responsibility for the child). or

The total income of household members is within the guidelines shown below (gross earnings before deductions, not take-home pay). Do not include as income: foster care payments, federal education benefits, MFIP payments, or value of assistance received from SNAP, WIC, or FDPIR. Military: Do not include combat pay or assistance from the Military Privatized Housing Initiative. The income guidelines are effective from July 1, 2016 through June 30, 2017.

CL District Student & Parent Handbook - Page 22Go on-line www.chisagolakes.k12.mn.us to view complete District Policies

Is this form required?

This form m

ust be completed to apply for free or reduced-price school m

eals, unless:(1) Y

our school provides free school meals to all students w

ithout applications from households (C

omm

unity Eligibility P

rovision, Provision 2 or P

rovision 3) or (2) Y

ou were notified that your children have been directly certified for school m

eal benefits based on foster care status or participation in the Supplem

ental N

utrition Assistance Program

(SN

AP

), Minnesota Fam

ily Investment P

rogram (M

FIP) or Food D

istribution Program

on Indian Reservations (FD

PIR

).

Privacy Act Statem

ent / How

Information Is U

sed The R

ichard B. R

ussell National S

chool Lunch Act requires the inform

ation on this application. You do not have to give this inform

ation, but if you do not w

e cannot approve your child for free or reduced-price school meals. Y

ou must include the last four digits of the S

ocial Security num

ber of the adult household m

ember w

ho signs the application. The last four digits of the Social S

ecurity number are not required w

hen you apply on behalf of a foster child, or you provide an M

FIP, S

NA

P or FD

PIR

assistance number, or you indicate that the adult household m

ember signing the application does not

have a Social S

ecurity number.

Only authorized officials w

ill have access to the information that you provide on this form

. We w

ill use your information to determ

ine if your child qualifies for free school m

eals, and for administration and enforcem

ent of the school meal program

s. We m

ay share your information w

ith other education, health, and nutrition program

s to help them evaluate, fund or determ

ine benefits for their programs, w

ith auditors for program review

s, and with law

enforcement

officials to help them look into violations of program

rules. We require w

ritten consent from you before sharing inform

ation for other purposes.

Please provide the requested inform

ation about children’s race and ethnic identity. This information is not required and does not affect approval for

program benefits. W

e use the percentages of participants in each racial/ethnic category to check that our program is operated in a nondiscrim

inatory m

anner in compliance w

ith federal civil rights laws

At public school districts, each student's school m

eal status also is recorded on a statewide com

puter system used to report student data to the

Minnesota D

epartment of E

ducation (MD

E) as required by state law

. MD

E uses this inform

ation to: (1) Adm

inister state and federal programs, (2)

Calculate com

pensatory revenue for public schools, and (3) Judge the quality of the state's educational program.

Information provided on this form

may be shared w

ith Minnesota H

ealth Care P

rograms, unless the person com

pleting this form has checked the box in

Step 4 to not share inform

ation for that purpose.

Nondiscrim

ination Statement

In accordance with federal civil rights law

and U.S

. Departm

ent of Agriculture (U

SD

A) civil rights regulations and policies, the U

SD

A, its agencies, offices,

and employees, and institutions participating in or adm

inistering US

DA

programs are prohibited from

discriminating based on race, color, national origin,

sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by U

SD

A. P

ersons with disabilities

who require alternative m

eans of comm

unication for program inform

ation (e.g. Braille, large print, audiotape, A

merican S

ign Language, etc.), should contact the A

gency (state or local) where they applied for benefits. Individuals w

ho are deaf, hard of hearing or have speech disabilities may contact

US

DA

through the Federal Relay S

ervice at (800) 877-8339. Additionally, program

information m

ay be made available in languages other than E

nglish.

To file a program com

plaint of discrimination, com

plete the US

DA

Program

Discrim

ination Com

plaint Form (A

D-3027) found online at:

http://ww

w.ascr.usda.gov/com

plaint_filing_cust.html, and at any U

SD

A office, or w

rite a letter addressed to US

DA

and provide in the letter all of the inform

ation requested in the form. To request a copy of the com

plaint form, call (866) 632-9992. S

ubmit your com

pleted form or letter to U

SD

A by:

(1) mail to U

.S. D

epartment of A

griculture, Office of the A

ssistant Secretary for C

ivil Rights, 1400 Independence A

venue SW

, Washington, D

.C. 20250-

9410, or (2) fax to (202) 690-7442; or (3) email to program

.intake@usda.gov. This institution is an equal opportunity provider.

Office U

se Only: Verification

Date V

erification Sent:

Response D

ue: 2

nd Notice: _

Result:

No C

hange Free to R

educed-Price Free to P

aid R

educed-Price to Free

Reduced-P

rice to Paid

Reason for C

hange: Incom

e C

ase number not verified

Foster not verified

Refused C

ooperation

Other: ______________

Signature of C

onfirming O

fficial: D

ate: S

ignature of Verifying O

fficial: D

ate:

CL District Student & Parent Handbook - Page 23Go on-line www.chisagolakes.k12.mn.us to view complete District Policies

Application for Educational B

enefits – School Year 2016-17 School M

eals State and Federally Funded Program

s Step 1

List all infants, children and students through grade 12 in the household, even if they are not related. If more space is needed, attach another sheet.

* The full names of the racial categories are: A

merican Indian or A

laskan Native, A

sian, Black or A

frican Am

erican, Native H

awaiian or other P

acific Islander and White.

Step 22 Do any H

ousehold Mem

bers, including yourself, currently participate in any of the following assistance program

s: SNA

P, MFIP or FD

PIR? C

ircle one:Yes No

Medical A

ssistance and WIC

do not qualify. If No > G

o to STEP 3.

If Yes > Write in the. C

ASE N

UM

BER

here: then go to S

TEP

4.

Step 3 A. List A

LL Adult H

ousehold Mem

bers including yourself and report all incomes. (S

kip STE

P 3 if you answ

ered “yes” to STE

P 2 or if all participants are foster children.)

B.Last four digits of signer’s Social Security N

umber (SSN

) or no SSN (required):

C. D

o any of the children listed in Step 1 receive regular incomes such as SSI or w

ages?

–or

I don’t have a Social

X X X

– X X TO

TAL

regular incomes of children, if any:

S

ecurity Num

ber .Step 45

I certify (promise) that all inform

ation on this application is true and correct and all household mem

bers and incomes are reported.I understand that this inform

ation is given in connection w

ith receipt of federal and state funds and that school officials may verify (check) the inform

ation. I understand that if I purposely give false information, m

y children may lose

benefits and I may be prosecuted under applicable federal and state law

s. The information I provide m

ay be shared with M

innesota Health C

are Program

s as allowed by state law

, unless I have checked this box:

Do notshare m

y information w

ith Minnesota H

ealth Care P

rograms.

Signatureof A

dult Household M

ember(required)

Print N

ame:

Date:

Address:

City

Zip H

ome P

hone: W

ork Phone:

Office U

se Only

Total Household S

ize: _____ Total Income: $

per A

pproved:C

ase Num

ber – Free Foster – Free

Income – Free

Income – R

educed-Price Denied:

Incomplete

Income Too H

igh Signature of D

etermining O

fficial: ____________________________ Date: _________

Child’s First N

ame

MI

Child’s Last N

ame

Birthdate

School

Grade

FosterC

hild? (A

n agency or court has legal responsibility for the child.) If yes, fill in the circle.

Optional -

Is the child H

ispanic / Latino?

If yes, fill in the circle.

Optional - R

acial Identity * Fill in one or m

ore circles for each child.

AmericanIndian

Asian

AfricanAmericanPacificIslander

White

Adults - Full N

ame

For the purpose of school meal benefits, the m

embers of your

household are “Anyone w

ho is living with you and shares incom

e and expenses, even if not related.” List the full nam

e of each household mem

ber not listed in Step 1 and

their income(s) in w

hole dollars. If a person has no income, w

rite in 0 or leave the section blank. This is your certification (prom

ise) of no income

to report. Include any college students temporarily aw

ay from hom

e.

Gross Pay from

Work

Do not w

rite in an hourly wage.

Farm or Self-

Employm

ent Public A

ssistance, C

hild Support, Alimony

All O

ther Incomes

Gross pay before

deductions(not take-hom

e pay).

Weekly

Bi-Weekly

2x Month

Monthly

Net Incom

e after business

expenses. S

tate if annualor m

onthly.

Paym

ents received.

Weekly

Bi-Weekly

2x Month

Monthly

Pension,

retirement,

disability, unem

ployment,

Veterans

benefits, etc.

Weekly

Bi-Weekly

2x Month

Monthly

$$

$ $

$$

$ $

$$

$ $

$$

$ $

$W

eeklyB

i-W

eekly2x

Month

Monthly

Please return completed form

to: C

hisago Lakes Schools – ISD #2144

Food Service Office

13750 Lake Blvd, Lindstrom

, MN

55045

Activities Department .......................................................................651-213-2528

Community Education ......................................................................651-213-2600

District Office ....................................................................................651-213-2000

Early Childhood & Family Education ..............................................651-213-2600

Early Childhood Special Education ..................................................651-213-2494

Food Service .....................................................................................651-213-2506

Pool ...................................................................................................651-213-2604

4.0 Chisago Lakes Bus Service .........................................................651-213-2020

Primary School .................................................................................. 651-213-2200

Lakeside Elementary ......................................................................... 651-213-2300

Taylors Falls Elementary .................................................................. 651-213-2100

Middle School ................................................................................... 651-213-2400

High School ...................................................................................... 651-213-2500

Chisago Lakes Education Center

Pathway To Change / SOAR ...................................................... 651-213-2071

Fairview Treatment ..................................................................... 651-213-8063

Chisago Lakes School District, ISD #214413750 Lake Blvd..Lindstrom, MN 55045Address Service Requested

Tel: 651-213-2000

www.chisagolakes.k12.mn.usPOSTAL

Non-Profit OrganizationU.S. PostagePermit No. 37Lindstrom, MN 55045

School DiStrict Phone DirectoryQuick reference

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