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Navarre Intermediate Center “Where Excellence Is a Tradition”

4702 W. Ford Street, South Bend, IN 46619

Telephone 283-7345 Attendance 283-7348 Fax 283-7351 Nurse’s Office 283-7394 Cafeteria 283-7355

Cristina Campos - Principal

Parent Newsletter Vol. 1 #01 August-September-October, 2016 (Published Quarterly)

Mission Statement “Navarre Intermediate Center strives to provide programs to meet the changing intellectual, creative, emotional, physical, and social needs of each student. Our school is committed to provide a supportive and safe environment which allows students to explore, develop, and broaden opportunities for personal growth and academic achievement. With the support of parents and community, Navarre Intermediate Center accepts the responsibility to prepare each student to be a contributing member of our diverse community.”

IMPORTANT DATES AND REMINDERS - Please Mark Your Calendars! (The complete SBCSC 2016-17 School Calendar is enclosed with this newsletter.)

Aug. 16 (Tues.) Open House (5:00 – 6:30pm) Aug. 17 (Wed.) Students’ First Day of School (Full Day 7:45 - 2:55) Sept. 5 (Mon.) Labor Day Holiday - School/Offices Closed Oct. 11 (Tues.) School Picture Day! (SMILE! ) Oct. 19 (Wed.) End of First Grading Period Oct. 20 (Thur.) NO SCHOOL for students – Teacher Record Day Oct. 21/24 Fall Break – School/Offices Closed (Fri./Mon.)

Please Plan to Attend Our Annual Back to School Night

at Navarre Intermediate Center on Tuesday, August 16, 2016

5: 00pm – 6:30pm

** Classes begin Wednesday, August 17th, 7:45am - 2:55pm! **

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Navarre Families, I hope that this letter finds you in good spirits! I cannot believe that summer vacation is wrapping up and we are preparing for another school year! We are looking forward to a wonderful partnership with you to ensure our children reach their highest potential. In order for our students to be successful, they must receive support from both the home and school. A strong partnership with you will make a great difference in your child’s education. As partners, we share the obligation for our children’s success and want you to know that we will do our very best to carry out our responsibilities. We ask that you guide and support your child’s learning by ensuring that he/she:

• Attends school daily and arrives on time

• Reads daily to develop a love of reading and improve their literacy skills

• Informs you if they need any extra support in school

• Shares school experiences with you so you are aware of their school life

• Knows that you expect them to succeed in school and go on to college Please “like” us on Facebook (Navarre Intermediate Center) or “follow” us on Twitter (@navarrejaguars) to check out all of the wonderful things we have going on! I am confident that we will have a successful school year!

2016-17 “NO SCHOOL” DAYS FOR NAVARRE STUDENTS

LABOR DAY - Monday, September 5, 2016 TEACHER RECORD DAY - Thursday, October 20, 2016 FALL BREAK - Friday & Monday, October 21 & 24, 2016 ELECTION DAY - Tuesday, November 8, 2016 THANKSGIVING BREAK - Wednesday, Thursday & Friday, November 23, 24, & 25, 2016 WINTER RECESS - Mon., December 26, 2016 – Fri., January 6, 2017 TEACHER RECORD DAY - Friday, January 13, 2017 MARTIN LUTHER KING DAY - Monday, January 16, 2017 PRESIDENT’S DAY - Monday, February 20, 2017 TEACHER RECORD DAY - Monday, March 20, 2017 SPRING RECESS - Monday, April 3 - Friday, April 7, 2017 SNOW DAY #1 - Monday, April 10, 2017 (unless needed as make-up) GOOD FRIDAY - Friday, April 14, 2017 SNOW DAY #2 - Friday, May 26, 2017 (unless needed as make-up) MEMORIAL DAY - Monday, May 29, 2017

MARTIN’S SUPER MARKET’S “ADVANTAGES FOR EDUCATION”

Navarre Intermediate Center is proud to announce that we will continue to be a part of the Martin’s Super Markets “Advantages for Education” program. To help us earn free educational equipment, simply visit the Customer Service Center at any Martin’s Super Market location and give them our school code, #4787. This will automatically earn credit for Navarre every time you use your Martin’s Advantage Card. If you do not have a card, you can get one at the Customer Service Counter. The students and faculty of Navarre Intermediate Center appreciate your help earning free educational equipment such as computers, sporting goods, band equipment, software, books and more!

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First Day of School School doors will open at 7:00am. After breakfast, all 5th and 6th grade students report to the small gym. All 7th and 8th grade students will remain in the cafeteria. The first bell rings at 7:40am and all 7th and 8th grade students report to their advisory classroom by 7:45. The 5th and 6th grade students will go to their classrooms. Lockers, emergency cards, and Agenda’s will be issued. Please make sure your child’s emergency card is completed and returned to school. All Students Receive Free Lunch at Navarre Intermediate Center Navarre Intermediate Center is qualified as a “Provision 3" school for the 2016-17 school year. All students enrolled at Navarre qualify for free meals.

** Please note that to receive free meals and/or textbook assistance, students will need to have an approved application. **

This application can be found at the South Bend Community School Corporation Website: “sbcsc.k12.in.us”.

Lunch and Breakfast Program Intermediate students have a “closed” lunch period and are not permitted to leave the school during their lunch period; nor may outside food be brought in/delivered to students. Navarre’s cafeteria also offers a school breakfast program. Items such as toast, juice, cereal, fruit, milk, hot chocolate and pancakes are available on a daily basis. Students eating breakfast are to go to the cafeteria beginning at 7:00am. Student Arrivals and Departures All arriving buses will load/unload students at the east Lombardy Street entrance. Parents who drive their children to/from school cannot use the east Lombardy Street drive. Please use the Ford Street drive-thru for dropping off/picking up your children. ALL STUDENTS MUST ENTER THROUGH DOOR’S 19 OR 20 (Lombardy Street)! Students are to leave the building when the dismissal bell sounds at 2:55pm. Students not involved in an approved after-school activity are to be out of the building and off school grounds by 3:05pm. Student safety requires that no one run between the buses. Students are to walk along the sidewalk to their buses. The bus picks up and drops off students at the same location in the bus lane each day. Students are also prohibited from walking through the parking lot located north of the Ford Street exit. Visitors’ Entrance - For Your Convenience! All school visitors should enter the building at the Lombardy Street entrance (Door #19). Classroom Visitors Interested parents and community members are welcome to visit Navarre Intermediate Center. All visitors are required to report to the attendance office on the Lombardy Street entrance. Parents may attend their children’s classes with an administrator’s and the teacher’s prior permission and an appropriate background check on file. NOTE: a copy of the background check has been included with this newsletter for your convenience. Simply complete and sign the form and have your child return it to their classroom teacher. Students are not permitted to bring guests to school. Navarre students may not go to another school unless accompanied by their parents.

All visitors must check in with the office upon entering the building.

Twenty-First Century Scholars Program Twenty-first Century Scholars Program parents/guardians are asked to call the toll-free number 1-888-603-5981 x235 to correct any information that might have changed since your child was enrolled in the Twenty-first Century Scholars Program. Correct information such as address, school attending, or phone number changes must be kept current to ensure scholars receive vital information. Bus Transportation Riding a school bus is a privilege that can be taken away. Bus drivers are expected to maintain order on the bus and should be treated by students as any other adult supervisor in school. The school will deny bus riding privileges to disruptive students. Activity Buses An activity bus is available for students who participate in after school or extra-curricular activities. These buses DO NOT drop students off at the same points of their regular bus pick up/drop off location. To ride this bus a student must wait in the designated area on Ford Street and not cause disruptions to school personnel or other activities. Students who misbehave or leave the designated area and/or school grounds will not be allowed to ride this bus. Student Dress and Grooming The building uniform policy (copy enclosed) is established to teach grooming and hygiene, instill self-discipline, prevent disruption, avoid safety hazards, and teach respect for authority. THE NAVARRE ADMINISTRATION RESERVES THE RIGHT TO DETERMINE IF DRESS IS APPROPRIATE FOR SCHOOL. If the principal determines that a student’s dress and/or grooming violates the dress code, the student will be given an opportunity to correct the problem at school. Telephones and Messages Students will not be excused from class to make or accept telephone calls except in extreme emergencies. The office will take messages and make every effort to relay urgent messages to students in a timely fashion. School phones are for office use only and may be used by students only in emergencies and with the permission of the person in charge. Classroom telephones are to be used by students only with the teacher’s

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permission and supervision. Parental support, cooperation, and patience with this school policy are appreciated. Note: Students are not allowed to have cell phones on their person during the school day. Cell phones may be kept in a locker; however, they will be immediately confiscated from students who are out of compliance with the school’s acceptable use of electronics policy. Navarre Intermediate Center is NOT responsible for lost, stolen or damaged cell phones and/or other devices (prohibited or allowed). Fee Statements Fee statements will be issued to students during the first month of school. Fee charges for individual students will vary depending on the course selections. Fee payments are made at the Education Center (215 S. Saint Joseph Street, 283-8000). If your household meets the federal guidelines for free lunch assistance, you also qualify for fee textbook assistance. Information on the application forms will come to your home in the August school corporation mailing. School Supplies A general supply list accompanies this bulletin. Students may receive a more detailed list of supplies needed from their individual teacher at the start of school. All students will be issued a Student Agenda/Assignment Notebook. They will be required to use it for the entire year. The student Agenda contains all the passes that each student will be allowed to use for the entire school year. If lost or stolen the Student Agenda must be replaced at a cost of $5.00 to the student. Parent-Teacher Communication Parents/guardians are encouraged to meet with their child’s teachers on a regular basis. To set up an appointment with an individual teacher or team of teachers please call the school. Emergency Cards An emergency card is to be completed for every student. The emergency card will provide information to school officials such as telephone numbers at home, parent work numbers, and the numbers of other individuals to be contacted when parents cannot be reached. Parents are required to inform the office immediately of any change in address or phone numbers to assist the school in making parent contact for academic, behavioral, or emergency reasons. Students must attend the school in the district where they reside with their parents. The address of the legal parent determines student residence unless a relative has legal guardianship. It is the duty of every parent to make sure that the school has adequate emergency information for their child. Students and/or parents who intentionally misrepresent this information will be dealt with accordingly. Immunizations Parents should know that their children are required by Indiana Law to have proper immunization against contagious diseases. Required immunizations include: polio, diphtheria, tetanus, pertussis (whooping cough), measles, rubella, and mumps. Students must also have a skin test for tuberculosis. Written records must be provided to the school. By Indiana Law, a child is not permitted to attend school for more than 20 calendar days beyond the date of enrollment. If you have questions about your child’s immunization or medical records please call the school nurse at 283-7394. Medication If your child will be taking medication while at school, please provide the school nurse with a current doctor’s order for the 2016-17 school year. The nurse can only accept medications accompanied with a current doctor’s order. The orders may be faxed to the school at 283-7351. Honor Roll Students are placed on the honor roll for maintaining a “B” or 3.0 average in all basic subjects. Students will be classified as “high honors” if they have an average grade point of 3.5 or above in all basic subjects. Progress Reports Progress reports are issued to students by each classroom teacher and sent home with the student during the 5th week of the grading period. Parents are advised to contact their child’s teachers if they do not receive these progress reports. Homework Homework is defined as any activity related to classroom curriculum and school learning which is completed outside of regular school hours without the immediate and direct supervision of the teacher. At Navarre, individual teachers and teams create their own homework policy to be followed by their students. In all cases, student homework assignments should complement classroom instruction, reinforce the learning which takes place during school hours, and build effective study and work habits. Homework may include assignments which provide students with independent practice on skills already learned, provide a foundation or background for upcoming topics, or challenge students by expanding upon something they have already covered. All students are expected to take down homework information when it is assigned by each teacher. It is the student’s responsibility to obtain all make-up work (due to absences) from his/her teachers. This work should be completed in approximately the same amount of time missed in class. Only in cases of prolonged medical absence will more than one week be allowed for work to be made up. Financial Obligations Students who owe debts may not be allowed to participate in extra-curricular activities, clubs, field trips, dances, or any end of the year recognition ceremonies. Debts owed include, but are not limited to, payments for lost or damaged textbooks or library books, money owed as a result of participation in a school sponsored fundraiser, restitution for damage done to the school, etc. Failure to pay these obligations may result in parents being referred to the Executive Director of Support Services for collection and/or legal action involving the Credit Bureau of South Bend - Mishawaka and/or small claims court. Withdrawals and Transfers Parents who are moving out of the SBCSC or who have permission to transfer their child to another SBCSC school must obtain a student transfer form from the office. This form must be completed and submitted to the office. A student is cleared once his/her locker is cleaned out, all textbooks and library materials are returned and all financial obligations are paid for. Notifying the School of Absences or Tardies Absences – A note is to be provided to the school stating the dates and reason for absence (even if the parent called the school during the absence).

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Failure to provide a written excuse within 48 hours will make an absence unexcused. An absence will be excused for personal illness, death in family, medical/dental appointments, religious observance, court appointments, authorized school-sponsored activities, college visits/military and service exams, and any other absences authorized by State law and/or principal). Note: Teachers are not required to provide make-up work to students for an unexcused absence. Tardies – No tardies will be considered excused. All tardies will be recorded on the student’s attendance record. A student coming to school after 7:45am is considered tardy. Students must have a note with them or a parent must call ahead to inform the attendance office that the student will be late. Any student arriving late without a call from a parent or a written note within 48 hours will be considered truant. Unexcused Absences and Truancies An unexcused absence will be recorded when the reason for the absence fails to qualify as one of the reasons listed above. Make up work may not receive full credit. Truancy is defined as being absent from school or any class, including homeroom, without the knowledge and consent of a students’ parents and the school, or being absent in violation of the School Attendance Law. Unexcused absences not acknowledged by a parent’s note within 2 school days of the student’s return are classified as truancies when/if the student’s attendance drops below 90% for the year. Students who leave a classroom, the building, or school grounds without permission will be considered truant. Leaving School It is important that the school know the whereabouts of each student at all times. No student may leave a classroom without a hall pass or the building or school grounds during school hours without an exit pass from the attendance office. Exit passes are only issued to students who need to leave school early for legitimate reasons. Exit passes are issued by the attendance office when requested by the school nurse or when a written request is received from the parents. Students who need an exit pass should take their note to the attendance office before first period in the morning. Students may be picked up only by parents in the office. Students who leave school during the day and return that day must check in at the attendance office to get an admit to return to class. Students must keep their exit pass to show the teachers whose class they missed upon returning to school. Hallway Rules: 1) Students are to walk at all times in the halls. 2) The stairs near the Teachers’ Lounge will be 7th grade ONLY during passing time. The center stairs will be 8th grade ONLY during passing

time. 3) Students are to go to classes using the shortest route allowed. 4) Any student in the hall during class time must have an individual hall pass. Cafeteria Rules: 1) All SBCSC schools maintain closed lunch hours (students may only eat in cafeteria). 2) Since classes are still in session, there must be silence in the halls as you walk to the cafeteria for lunch and/or recess and then back to

class afterwards. 3) Lunch lines are to be single file (pushing, cutting, or the saving of places is not allowed). 4) Tables are not to be moved (only one student per seat at each table). 5) Boys and girls will be seated at separate tables. Zero Tolerance for Profanity There will be a policy of zero tolerance on the use of profanity at Navarre Intermediate Center. The use of profanity is unacceptable and students will not be allowed to use it at Navarre Intermediate Center. Zero Tolerance for School Violence In response to the nationwide increase in juvenile violent crime, the administration at Navarre Intermediate Center is prepared and committed to make our school safe for all students and staff members. Since we stress and expect students to deal with anger and verbal abuse in a responsible and respectful manner, fighting * or other violent actions committed (in or out of school) to solve a problem or settle a score/grudge will absolutely not be tolerated under any circumstances at Navarre Intermediate Center! Students who engage in fighting are subject to not only appropriate school punishments (i.e., In-School Suspension, Out-of-School Suspension, and possible Due Process) but legal action as well. As an example, fighting in a public place is considered “Disorderly Conduct” (see IN Criminal Law 35-45-1-3) and the school is prepared to initiate legal action against students for such unlawful conduct. The school has been encouraged by the St. Joseph Co. Probate court to pursue legal action against all students who engage in such unlawful conduct in school by filing a criminal report with the South Bend Police Department. In such cases, if a parent is not available to pick their child up from school the police officer taking the report will escort the child to the St. Joseph Co. Juvenile Justice Center where s/he will await their parents. Meanwhile, the South Bend Police Department will forward their report to the St. Joseph Co. Probate Court. The court contacts the student, parent, school regarding court dates, action, etc. PLEASE NOTE: Two students who fight (i.e., both individuals exchanging blows) is not the same as a student who hits another student who, in response, does not hit back. In the first incident, the school is the victim of “Disorderly Conduct” and may seek legal relief. In the second incident, the student who was struck (and did not strike back) is the victim of “Assault” and/or “Battery” and may seek legal relief. Zero Tolerance for Drugs in School Knowingly possessing, using, transmitting, selling, or being under the influence of any substance that is, looks like, or contains alcohol, a narcotic drug, hallucinogen, amphetamine, barbiturate, marijuana, intoxicant, any caffeine-based substance, phenylpropanolamine (PPA), or stimulants of any kind, available with or without a prescription will not be tolerated. The SBCSC has approved the use of drug dogs to conduct random locker searches (see Educ. Policy 7321) throughout the corporation for your protection. Individual schools will not be warned in advance of these searches. A Code Red drill will be used to conduct these searches and the dogs will never be used to search any person. Athletic Physicals According to policies established by the South Bend Community School Corporation (SBCSC), every athlete trying out for a sport must have a physical examination on file. The completed physical forms must be given to the coach by the first day of practice. Physicals given after June 1st are good for twelve months. We recommend you receive your physical from your family physician. Physical forms are available in the main office.

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Athletic Insurance The SBCSC Athletic Department will again provide supplemental Athletic Insurance through Student Athletic Protection, Inc. (SAPI) of Kalamazoo, Michigan. Our records clearly indicate there is a need for this coverage that supplements family/employer insurance and often provides basic benefits when the family has no insurance. Though the Protection Plan covers most claims, including dental work, you should know that all claim payments are supplemental. That is, the family/employer plan must pay for the injury to its limits before the SAPI Plan begins to pay. There are other conditions and limits: The first $500.00 in claims on SAPI is co-paid by the family and SAPI. There are limits on dental work, doctors’ office calls, therapy, replacement of glasses, prescribed drugs and apparatus. The following are not covered: hernia, injury due to fighting, disease or sickness in any form, preventive appliances and electrical biomechanical devices. The 2016-2017 athletic insurance premium for Intermediate Center students is $20.00. Each school must pay a premium for each participating student. There are no exceptions. If you have medical bills for your child’s athletic injury and you have family employer insurance, file a claim with your fam ily/employer carrier first. When you have a claim for the SAPI Plan, please contact Navarre Intermediate Center (283-7345). All claims will be settled in keeping with the SBCSC athletic insurance plan with SAPI. When you contact us, we will advise you on your coverage and the action you must take to file your claim with the Kalamazoo office of the SAPI. All claims must be filed with the school no later than 365 days following an injury. If you have any questions at any time regarding the athletic insurance plan, please call the school. Navarre Intermediate Center Athletics

* Insurance - An athlete must pay for insurance before they are allowed to participate in practice. Each sport an athlete participates in will have an insurance cost of $20.00.

*Ten Day Rule - Athletes must practice in 8 practices - 1 per day - before they can participate in an athletic contest. Any athlete that

misses 5 or more practices must have a physician’s release in order to return to the team. *Age Eligibility - 6th grade/A student who is or shall be 14 prior to or on the scheduled date he last contest in a sport should be

ineligible for athletic competition in that sport.

- 7th grade/A student who is or shall be 15 prior to or on the scheduled date of the last contest in a sport should be ineligible for athletic competition in that sport.

- 8th grade/A student who is or shall be 16 prior to or on the scheduled date of the last contest in a sport should be

ineligible for athletic competition in that sport. *Academic - Athletes must have received Statement passing grades in at least 7 out of 8 credit subjects or the equivalent in the

previous grading period. Quarterly GPA must be at least 2.0.

ATTENTION ALL ATHLETES!

FOOTBALL (6th/7th/8th GRADES ONLY)

CROSS COUNTRY (GRADES 5 - 8)

VOLLEYBALL (GRADES 6 - 8 ONLY)

SOCCER (GRADES 5 - 8)

NAVARRE INTERMEDIATE ATHLETICS IS LOOKING FORWARD TO A GREAT FALL SEASON!

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NAVARRE INTERMEDIATE CENTER

School Supply List 2016-2017

5th Grade

24 No. 2 pencils (needed daily for entire year)

Pens (black/blue and red ink) Colored pencils

Markers 4 loose leaf paper packages

Large eraser Dry erase markers with eraser

10 spiral notebooks 4 boxes of tissue

1 jump drive/memory sticks 1 container of Clorox Wipes

1 bottle of hand sanitizer 12 folders with pockets- all different colors

4- 5 glue sticks Binders optional

6th Grade

6 folders 4 to 6 spiral notebooks

2 composition notebooks 1 binder (1” or larger)

1 pack of dry erase markers Pencils for the year 2 black or blue pens

1 red pen 4 pack loose-leaf paper (wide ruled)

1 box of Kleenex 1 calculator

1 box markers 1 box colored pencils

1 bottle Hand Sanitizer

7th Grade

FOR ALL CLASSES:

2 packages of white, loose-leaf notebook paper (college ruled)

Ink pens AND pencils Colored pencils, markers and crayons

2 highlighters USB storage device

Glue sticks

MATH/SCIENCE: 2-inch, 3-ring binder with dividers (for use only in Math)

Protractor Ruler with inches and metrics (cm/mm)

Scientific Calculator – recommended TI 30X IIS – DO NOT buy a graphing calculator

Folders Spiral notebooks

Composition book (for use only in Science)

LANGUAGE ARTS/SOCIAL STUDIES: 2-inch, 3-ring binder with dividers (for use only in

English/Reading) 2-inch, 3-ring binder with dividers (for use only in

Social Studies) Folders

Spiral notebooks

ADVISORY (HOMEROOM) 2 boxes of tissue for Advisory

2 Dry erase markers for Advisory

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8th

Grade 2016-2017

School Supplies

Navarre Intermediate Center

Each 8th

Grader will need: One 2-3 inch binder

One pencil pouch with three holes to put in binder

8 binder dividers

8 three hole punched folders

3 spiral notebooks*

20 pencils*

Pens (assorted colors)

200 sheets of loose leaf paper*

100 lined index cards

Highlighters

*More may be needed throughout the school year.

Each 8th

Grader will need the following for

projects throughout the year: Poster boards

Colored pencils

Glue or glue sticks

Permanent markers

Each 8th

Grader will need to turn in to their

Advisory teacher during the first week of school to

be used throughout the school year in classrooms: One box of tissue

One pack of markers

One pack of crayons

One bottle of hand sanitizer

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PLEASE REVIEW CAREFULLY!!

Navarre Intermediate Center Uniform Policy – 2016-2017 Bottoms

o Navy blue, black or khaki pants

o Navy blue, black or khaki shorts - must be at or below the knee

o Navy blue, black or khaki capris - knee length

o No rolling up or rubber bands at the bottom of pants, no joggers

o Pants must be worn at the waist – NO SAGGING

o Appropriate fitting clothing – no leggings or jeans

Skirts and Jumpers

o Navy blue, black or khaki solid color

o Must be at or below the knee

o Must be worn with uniform shirt

Tops

o Polos, dress shirts, button downs and blouses with collars are allowed

o Must have sleeves and collar

o Navy blue or white solid color shirt

o Tucked in at all times

o Only 1 top button unbuttoned

o May wear a knit cardigan or pull over sweater/sweatshirt over the collared shirt

Navy blue or white - plain solid color

Hoods are never allowed

No zippers

No pockets

o Undershirts or turtlenecks must be uniform color

o No oversized clothing

o May wear spirit wear (Navarre Logos) over your collared shirt

Feet

o No high heels, house shoes, slippers, or flip-flops allowed

o BOOTS ARE NOT ALLOWED DURING THE SCHOOL DAY

This includes visible knee high or mid-calf shoes and boots

Head

o No hats, no scarves, no bandanas

Jewelry

o No visible piercings other than earrings that deter from the educational setting

o no fashion glasses, sunglasses, or costume jewelry allowed Students

*** Students should be in compliance with the dress code and dressed for success at the time they arrive

on school property. Administration reserves the right to determine if student clothing is appropriate. ***

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SOUTH BEND COMMUNITY SCHOOL CORPORATION

215 South St. Joseph Street South Bend, Indiana 46601

Telephone (574) 283-8000

Volunteer Application Form

Consent to Criminal History Background check PLEASE PRINT CLEARLY AND COMPLETE ALL FIELDS:

List each of the school(s) at which you would like to volunteer (required): (1) (4) (2) (5)

(3) (6)

Last Name: (Please print)

First Name: MI:

List all other names you have used including maiden name:

Date of Birth (mo/day/year): / / SSN#: - - Current Address:

☐ Male ☐ Female ☐ White ☐ Black ☐ Multi Race ☐ Hispanic

☐ American Indian/Alaskan ☐ Asian/Pacific Islander ☐ Unknown

Email Address:

Telephone Number: Please place a check in the box to indicate the reason(s) for volunteering: ☐ Parent/Guardian ☐ Community Volunteer ☐ Corporate/Organization Volunteer*

☐ Other______________________________________________

* Employer/Organization Represented: (REQUIRED if Corporate/Organization Volunteer is selected above)

Address:

Email Address: Telephone Number:

VOLUNTEER CONSENT AND RELEASE STATEMENT

Please read carefully before signing

I certify that the information contained on this application as submitted is true, complete and accurate to the best of my

knowledge. I understand that falsification of information submitted as part of my application to provide volunteer services

will be cause for my disqualification. I also understand that I am required to submit to a criminal history background

check as a condition for consideration of volunteer services. If I am accepted as a volunteer, I understand and agree to

abide by the rules and guidelines of the Board of School Trustees. I understand that the South Bend Community School

Corporation is not responsible for any injury to my property or my person while I am acting as a volunteer.

_________________________________________ _____________________________

Applicant Signature Date