19 TAC Chapter 89, Subchapter BB 89.1215

The State of Texas requires that the following information be completed by parent or guardian (or student if Grades 9-12): The State of Texas requires that the following information be completed for each student who enrolls for the first time in a Texas Public School. It is the responsibility of the parent or guardian, not the school, to provide the language information requested by the questions below. This survey shall be kept in each student's permanent record folder.

Debe de completarse por el padre/madre/o representate legal (o por el estudiante si esta en los grados 9-12): El estado de Texas requiere que la sigiuente informacion se complete pasa cada estudiante que se matricula por primera vez en una escuela publica de Texas. Es la responsabilidad del padre o tutor, no de la escuela, proporcianar la informacion del idioma requerida por las siguientes preguntas. Este cucstionario se archivara en el expediente del estudiante.

Please mark only one language for each question.

NOTE: If you believe you made an error when completing this Home Language Survey, you may request a correction, in writing, only if: 1) your child has not yet been assessed for English proficiency, and 2) your written correction request is made within two calendar weeks of your child's enrollment date.

NOTA: Si cree que cometio un error al completar este cuestionario sobre el idioma que se habla en el hogar, puede solicitar una correcion, por escrito, solo si: 1) su hijo(a) aun no ha sido evaluado para el dominio dol ingles; y 2) su solicitud de correccion per escrito se realiza dentro do las dos semanas calendario posteriores a la fecha de inscripcion de su hijo(a).

Pursuant to section 29.081(b) of the Texas Education Code (TEC), school districts in Texas are required to provide accelerated instruction to students who are at risk of dropping out of school. Additionally, school districts are required to evaluate and document the effectiveness of the accelerated instruction in reducing the dropout rate and in increasing achievement of students who are at risk of dropping out of school. HB 7, passed during the 85th Legislative session (2017), modified the criteria for identifying a student as "at risk of dropping out of school" to read as follows:

P.O. Box 87 Liberty Hill, TX 78642 Phone: 512-528-2150 Fax: 512-515-5875

SPECIAL EDUCATION RECORDS AND GENERAL EDUCATION RECORDS

NOTICE FOR RELEASE/CONSENT TO REQUEST CONFIDENTIAL INFORMATION

We are asking that you authorize the person or agency named below to release specified records containing confidential information regarding the above-named student to the following school staff person:

*Please fax or e-mail IEP/TRANSCRIPT*

The student's current and previous school district are not required to obtain parental consent before requesting or sending the student's special education records if the disclosure is conducted in accordance with 34 CFR 99.31. In Accordance with TEC 25.002, the school district in which the student was previously enrolled shall furnish the new school district with a copy of the student's records, including the child's special education records, not later than the 30th calendar day after the student was enrolled in the new school district (89.1050(f).

P.O. Box 87 Liberty Hill, TX 78642 Phone: 512-528-2150 Fax: 512-515-5875

NOTICE FOR RELEASE/CONSENT TO REQUEST CONFIDENTIAL INFORMATION

We are asking that you authorize the person or agency named below to release specified records containing confidential information regarding the above-named student to the following school staff person:

Do not add anything, signature only please. *This is authorization for Inspire Academies to share records with Meridell.*

The student's current and previous school district are not required to obtain parental consent before requesting or sending the student's special education records if the disclosure is conducted in accordance with 34 CFR 99.31. In Accordance with TEC 25.002, the school district in which the student was previously enrolled shall furnish the new school district with a copy of the student's records, including the child's special education records, not later than the 30th calendar day after the student was enrolled in the new school district (89.1050(f).

§ 97.65 of the TAC states, "A parent or physician validated history of varicella disease (chickenpox) or varicella immunity is acceptable in lieu of vaccine. A written statement from a physician, or the student's parent or guardian, or school nurse must support histories of varicella disease." School nurses may also write this statement to document cases of chickenpox that they observe. The school shall accurately record the existence of any statements attesting to previous varicella illnesses or the results of any serologic tests supplied as proof of immunity, The original should be returned to the child/student or the child's/student's parent or guardian. If a child or student is unable to submit such a statement or serologic evidence, varicella vaccine is required.

§ 97.65 of the TAC states, "A parent or physician validated history of varicella disease (chickenpox) or varicella immunity is acceptable in lieu of vaccine. A written statement from a physician, or the student's parent or guardian, or school nurse must support histories of varicella disease." School nurses may also write this statement to document cases of chickenpox that they observe. The school shall accurately record the existence of any statements attesting to previous varicella illnesses or the results of any serologic tests supplied as proof of immunity, The original should be returned to the child/student or the child's/student's parent or guardian. If a child or student is unable to submit such a statement or serologic evidence, varicella vaccine is required.

§ 97.65 del TAC declara, "Un historial de enfermedad de la varicela o immunidad contra la varicela documentado por el medico, o por el padre del nino o estudiante es aceptable en vez de la vacuna. Un informe por escrito de parte del medico, padreo tutor legal del nino o estudiante, o de parte de la enfermera de la escuela debe apoyar historiales de la enfermedad de la varicela." La enfermera de la escuela tambien puede documentar por escrito cualquier caso de varicela que haya ocurrido en la escuela. la escuela debe anotar correctamente la existencio de cuolquier documentacion atestando a cualquier enfermedad de varicela o el resultado de prueba serologica dada como prueba de immunidad. El documento original se debe devolver al nino o estudiante o al padre o tutor legal del nino o estudiante. Si el nino o estudiante no puede someter tal informe o evidencia serologica, la vacuna contra la varicela se requiere.

La enfermedad de la varicela debe ser documentada por medio de los siguientes medios de informe:

Physical Address: 1100 West 49th Street, Austin, Texas 78756 (800) 252-9152 Mailing Address: MC 1946, PO Box 149347, Austin, Texas 78714-9347 (800) 252-9152

Upon enrollment, each student takes a diagnostic pre-test in reading and mathematics in order to determine educational strengths and weaknesses, and the student receives an individualized course schedule and instructional arrangement based on academic need. Although classrooms are multi-grade, each student will receive appropriate on-grade level instruction in the Texas Essential Knowledge and Skills. The John H. Wood Jr. Public Charter District is fully accredited.

The day at each campus begins with a familiar structure (Pledge of Allegiance, Moment of Silence, school announcements, recognitions, etc.),and each classroom has a structure (greeting, warmup, lesson, practice, closure). Classroom instructions is SACRED: Structured, Accountable, Caring, Relevant, Educational, Dynamic. Teachers create engaging lessons that create positive learning experiences for students in a technology-rich classroom environment that encourages hands-on learning. Students who need additional educational services will receive them.

The campus and district uses C-SCOPE as its curriculum, along with supplemental computerized programs designed to accelerate learning and assist students in the credit recovery process. Students take formative and summative assessments, including unit assessments, benchmark tests and final exams for their courses, and all students participate in state assessments annually.

The patient has previously been diagnosed with:

Outpatient Therapy, Therapist, Psychiatrist, etc, in the last couple of years?