For School Use Only. As the administrator responsible for student admissions, I have reviewed the student application and have concluded that, to the best of my knowledge, it is accurate and complete; I attest that documents verifying income and residency are on file at the school and that the student has been accepted for admission pending approval of a Choice Scholarship. Based on the information provided by the parent or guardian, the student is eligible. Yes No Signature of school administrator or designee Date of signature (month, day, year)
For School Use Only. This Medical History Form was reviewed by: Printed Name Date Signature PREPARTICIPATION PHYSICAL EVALUATION -- PHYSICAL EXAMINATION Student's Name _________________________________ Sex _______ Age _______ Date of Birth _________________________ Height ______ Weight________ % Body fat (optional) ________ Pulse __________ BP____/____ (____/____, ____/ ) brachial blood pressure while sitting Vision R 20/______ L 20/___ Corrected: Y N Pupils: Equal Unequal As a minimum requirement, this Physical Examination Form must be completed prior to junior high athletic participation and again prior to first and third years of high school athletic participation. It must be completed if there are yes answers to specific questions on the student's MEDICAL HISTORY FORM on the reverse side. * Local district policy may require an annual physical exam. NORMAL ABNORMAL FINDINGS INITIALS* MEDICAL Appearance Eyes/Ears/Nose/Throat Lymph Nodes Heart-Auscultation of the heart in the supine position. Heart-Auscultation of the heart in the standing position. Heart-Lower extremity pulses Pulses Lungs Abdomen Genitalia (males only) Skin Xxxxxx’s stigmata (arachnodactyly, pectus excavatum, joint hypermobility, scoliosis) MUSCULOSKELETAL Neck Back Shoulder/Arm Elbow/Forearm Wrist/Hand Hip/Thigh Knee Leg/Ankle Foot *station-based examination only CLEARANCE 🞏 🞏 Cleared Cleared after completing evaluation/rehabilitation for: __________________________________________________________ 🞏 _________________________________________________________________________________________________________ Not cleared for:_________________________________________Reason: _________________________________________ Recommendations: _________________________________________________________________________________________ _________________________________________________________________________________________________________ The following information must be filled in and signed by either a Physician, a Physician Assistant licensed by a State Board of Physician Assistant Examiners, a Registered Nurse recognized as an Advanced Practice Nurse by the Board of Nurse Examiners, or a Doctor of Chiropractic. Examination forms signed by any other health care practitioner, will not be accepted. Name (print/type) __________________________________________ Date of Examination: _______________________ Address:_____________________________________________________________________________________________ Phone Number: _______...
For School Use Only. Minimum GPA of 2.0 Yes No Grade earned while in Course: Counselor’s Signature Date: Approved Denied Administrator’s Signature Request Denied for the following reason(s): Please complete the the back page: Santa Xxxx High School PEER TUTOR GRADING RUBRIC Exemplary Meets Minimal Expectations Needs Improvement Numerical Value 5-6 3-4 0-2 For each characteristic place a point value in the Attendance & Punctuality Student has 90% attendance and is prompt. Attendance is reliable. Student contacts treacher in advance regarding absences or tardies Student attends regularly and is generally on time. Student usually contacts treacher in advance regarding absences or tardies Student’s attendance is less than 75% tardiness is noticeable. Student seldom contacts teacher if/when absent or late Ability to carry out directions & assigned tasks Student’s execution of assigned tasks/duties meets or exceeds teacher’s expectations and contributes positively to the classroom. Work is carried out with creative & enthusiastic energy Students carried out assigned tasks/duties as expected, with little or no supervision necessary. Work is generally satisfactory although it lacks positive energy. Student’s execution of task/duties is irregular, and teacher needs to monitor/redirect or remind fairly often. Attitude & communication skills Student’s communication with students and teacher helps create a positive, friendly tone in the classroom/school. Student is upbeat and positive. Student is generally positive and responsive to teacher and or students. Student takes direction positively form teacher. Student may be uncommunicative at times Students attitude does not contribute positively to the classroom atmosphere: student may be reticent, negative, inappropriate Effectiveness with children Students encouraging, cheerful, proactive communication with students is evidenced by increased engagement on-task time and learning children. Student reliably directs/leads children activities/learning Student generally encourages students. Student is patient and keeps students on task as directed by the teacher. Student xxx xxx lapses in attention while monitoring/tutoring children Student may sometimes be inappropriate in tome, word or action with students. Sutent may not always make good decisions in directing/tutoring children Initiative & Conscientiousness Student needs very little supervision because she/he is able to see what needs to be done, then does it. Student has “feel” for what the...
For School Use Only. Registry Has Been Checked Registry is Clear Child Abuse Training Completed Copy to School Police
For School Use Only. Registry Has Been Checked Registry is Clear Child Abuse Training Completed Copy to School Police Today's date By signing below, I acknowledge that I have been provided with, and have completed the Child Abuse Reporting Training via the online training program. I understand that as a school volunteer in the state of Georgia, I am a mandated reporter of child abuse and neglect and as such, will fulfill these responsibilities to the best of my ability. I also understand that if I need any additional training or have any questions regarding the Child Abuse Reporting Protocol, I can obtain assistance from the School Principal or the School Social Worker. Volunteer's Printed Name Volunteer's Signature Date Training Completed
