Amharic Chancellor Enrollment letter.Final work file 2014 ... · ñ½ [ 2014-2015 Õp 0p Á p...
Transcript of Amharic Chancellor Enrollment letter.Final work file 2014 ... · ñ½ [ 2014-2015 Õp 0p Á p...
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1200 Firs t Street NE | Washington, DC 20002 | T 202.442.5885 | F 202.442.5026 | www.dcps.dc.go
(April) 1, 2014
2014-2015 (DCPS)
(“Nation’s Report Card”)
(PWP) $5
$ 50
?
(April) 1:(May) 1:
June) 20: 2013-2014
(Office of StudentEnrollment and School Funding) 202-478-5738
2014 – 2015
Kaya Henderson
Letter to Parents - Enroll Early (Amahric)
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1200 Firs t Street, NE | Washington, DC 20002 | T 202.478.5738 | F 202.442.5026 | dcps.dc.gov
2014-2015 !
www.dcps.dc.gov/enroll
www.dcps.dc.gov/enroll
(Chancellor’s Response Team) 202-478-5738
_________________________________________ _________________________________________________
/
2014-20152014-2015 “ ”
(required) 2014-2015
/
(June) 20, 2014 ( (May)) 1, 2014
2014-2015
( )................................................................................................... 3
( ................................................................................... 4
( )………………………………………….……………………..……………………….……. 5
...................................................................................................................................... 7
( )
( 7-12 )
“ ”
............................................................................................................. 9
2014-2015 ...................................................................................................... 10( ...................................................... 12
( ..................................................................................... 16Human Papilloma
Virus (HPV)) ( 6-11 )........................................................................................................ 18HPV ( )...................................................................... 19
(FARM) ................................................................................... 20................................................................................................... 21
FERPA ..................................................................................................................................…… 22
2014-15 Enrollment Packet Check list (Amharic)
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2014 - 20152014 – 2015 2014 – 2015 _____________________
#: ________________
*(April) 1
_____________________________________________________________________ _____________________________________* / 18
STUDENT INFORMATION)1. 2. 3. Middle Name 4. 5.
6. 7. . 8.
9. 10. 11.
12. 13.
14.
/ /
___________ - ___________15.
__________________________ _______________IEP
IEP_________________
504
16. .. . .
17. 17b. -
*
18. 19.
.
*20.
@ ( )
21.( ) ( )
( ))
22.)
23.
2014-15 Enrollment Form (Amharic)
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(primary caregivers)2014 – 2015
October) 5, 2014 10
(April) 1 (April) 1, 2014)
parent/guardian/caregiver whose residency documents are submitted at the time of enrollment.
1)
1. 5.
2. 6. D-403. 7.
4.
2)1 (2)
1. 3.
2. 4. (2
Student Residency Office 1200 First St.NE, 9th Floor (202) 442-5215
1200 First Street, NE | Washington, DC 20002 | T 202.478-5738 | F 202.442.5024 | www.dcps.dc.gov
(1) (2)
www.dcps.dc.gov/enroll.
Residency Verification Guideline (Amharic)
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DCPS Home Language Survey (HLS) FormComplete this Home Language Survey at the Student’s initial enrollment in a DC Public School.This form must be signed and dated by the Parent or Guardian. This form must be kept in the student’s file.
School: ________________________________________ Student ID #: ___________________________________
Student’s Last Name: _____________________________ Student’s First Name_____________________________
English1. Is a language other than English spoken in your home?
No Yes ___________________________ (specify language)2. Does your child communicate in a language other than English?
No Yes ___________________________ (specify language)3. What is your relationship to the child?
Father Mother Guardian Other (specify)___________
If the answer to question 1 or 2 is “Yes”, the law requires your child’s English languageproficiency to be assessed.
Español (Spanish)1. ¿Se habla otro idioma que no sea el inglés en su casa?
No Sí _________________________(idioma)2. ¿Habla el estudiante un idioma que no sea el inglés?
No Sí ________________________(idioma)3. ¿Cuál es su relación con el estudiante?
Padre Madre Guardián Otro (especifique)_________
Si la respuesta a la pregunta 1 ó 2 es “ Sí “, la ley requiere que se evalúela fluidez de su hijo/a en el idioma inglés.
Français (French)1. Parlez vous une langue autre que l'anglais à la maison ?
Non Oui ______________________ (spécifiez la langue)2. Votre enfant communique t il dans une langue autre que l'anglais ?
Non Oui ______________________ (spécifiez la langue)3. Quel est votre relation avec l'enfant ?
Père Mère Tuteur Autre (spécifiez) __________
Si la réponse à la question 1 ou 2 est “ Oui “ , la loi exige que lescompétences de votre enfant en anglais soit évaluées.
(Chinese) 1.
_________________________ ( )
2. ________________________ ( )
3.
( ) ____________
Ti ng Vi t (Vietnamese) 1 Có ngôn ng nào khác ngoài ti ng Anh c nói nhà quý v không? Không Có __________________________ (xin ghi rõ ngôn ng nào) 2 Con em quý v có nói m t ngôn ng nào khác ngoài ti ng Anh không? Không Có __________________________ (xin ghi rõ ngôn ng nào) 3. Xin cho bi t liên h c a quý v v i con em? Cha M Giám h Liên h khác (xin ghi rõ) ________________________________________________________
N u tr l i c a câu h i 1 ho c 2 là “ Có ”, lu t l òi h i con em quý v ph i
c th m nh trình thông th o Anh ng .
(Amharic)
1. ? __________________________ ( )
2. ? __________________________ ( )
3. ? ___________ ( )
1 2 ”
School Official’s Comments:
___________________________________________________ __________________________________________________School Official Signature Date Parent/Guardian Signature Date
REGISTRAR PROCESS:
If a parent/guardian does not speak English and yourschool does not have staff that speaks theparent/guardian’s language, please use the LanguageLine for communication.
If the HLS indicates a language other than English isspoken in the home, give the family the Referral Letterand refer the family to the Intake Center forassessment and orientation.
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1200 First Street, NE | Washi
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__________________ ______________________________________________
___________________________________________________________________________________________________
7–12
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_______________________________________
__________________________________________
http://dcps.dc.gov/DCPS/About+DCPS/Human+Resources/Notice+of+Non
1200 First Street, NE | Washington, DC 20002 | T 202.478-5738 | F 202.442.5024 | www.dcps.dc.gov
/
(DCPS)
(DCPS)
( ).
_____________________________________ ___________________________________________
______________________________________________
___________________________________________________________________________________________________
LEA)
30
__________ _____________________
__________________________________________ _______________________
CPS/About+DCPS/Human+Resources/Notice+of+Non-Discrimination
Consent & Release for Student to be filmed/photographed/intervi
| www.dcps.dc.gov
/
(DCPS)
.
_____________________________________ ___________________________________________
____________________
___________________________________________________________________________________________________
_____________________________________________
__________________________________________
Consent & Release for Student to be filmed/photographed/interviewd & Use of Image/Voice (Amharic)
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1200 First Street, NE | Washington, DC 20002 | T 202.478.5738 | F 202.442.5024 | www.dcps.dc.gov
2014-2015
-12PK3 -12th)) 365
365
( ?http://dhcf.dc.gov/service/dc-healthy-families)
(12
(PK3-12)10 DC Department of Health Immunization
Division) 202-576-9325
PK3 -12th))(
http://www.insurekidsnow.gov/state/dc/district_oral.html)
? 1-866-758-6807 http://dhcf.dc.gov/service/dc-healthy-families)
HPVHPV
(2 )
6-11 6-11 HPVHPV
www.dcps.dc.gov
http://tinyurl.com/qhibhms.
anaphylaxis)http://tinyurl.com/qzisu6t
http://tinyurl.com/kwf8386. anaphyla-xis)
medication actionplan)
Diana Bruce [email protected].
2014-15 School Health Checklist (Amharic)
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2
(Preschool)Head Start
4 (Diphtheria/Tetanus ( )/Pertussis (DTaP)
3 (Polio)1 Varicella, (chickenpox )) –
2
1 Measles ( ), Mumps ( ) Rubella (MMR))3 (Hepatitis) B2 (Hepatitis) A3 4 Hib (Haemophilus Influenza ( ) Type B 34 (PCV (Pneumococcal))
4
(Pre-Kindergarten)
5 (Diphtheria/Tetanus ( )/Pertussis (DTaP)
4 (Polio)2 Varicella, (chickenpox )) –
2
2 Measles ( ), Mumps ( ) Rubella (MMR)3 (Hepatitis) B2 (Hepatitis) A3 4 Hib (Haemophilus Influenza ( ) Type B 34 (PCV (Pneumococcal))
5 (Diphtheria/Tetanus ( )/Pertussis (DTaP)
1
2014 – 2015/
/
ONECITY
(Amharic)
5 – 10
11
12
/Pertussis (DTaP)
4 (Polio)2 Varicella, (chickenpox )) –
2
2 Measles ( ), Mumps ( ) Rubella (MMR)3 (Hepatitis) B2 (Hepatitis) A ( 01/01/05 )
5 (Diphtheria/Tetanus ( )/Pertussis (DTaP)
1 Tdap (if five years since last dose of DTP/DTaP/Td)4 (Polio)2 Varicella, (chickenpox )) –
2
2 Measles ( ), Mumps ( ) Rubella (MMR))3 (Hepatitis) B1 Meningococcal3 Human Papillomavirus (HPV) – 6-11
www.doh.dc.gov
1
2 Varicella/chickenpox ( ) (MD, NP, PA, RN) /
3
Rev 02-14
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www.doh.dc.gov
February) 24, 2009 (DCUHC)
Child Care) (Head Start) parochial schools) .
EPSDT DCUHC 21
the American Academy of Pediatrics (AAP))
1974 (FERPA)1996 Health Insurance Portability and Accountability Act of 1996 (HIPAA))
1:
“other” (“ ”)
“none”( 5
2:
AAP
WT: (LBS) (KG); HT: (IN) (CM).
BP:
2 A
Body Mass Index (BMI)) 2 BMI
HGB/HCT:Hemoglobin (HGB) Hematocrit (HCT) Head Start AAP
(anemia) HGB, HCT
“ “ ”
(Rx)
“ ”‘ ”
“ ” – 12
“ ”
:
“NONE” (
:
“NONE” (
:
NONE”
2 : Section C
.
3:
(TB) AAP Tuberculin 2006 AAP RED BOOK, 27th Ed., 682.TST ( child care)
TST (negative ( positive (
.TST positive( X-Ray ( (CXR) TSTs
DCT.B ( 202-698-4040
6 14 22 26 26
6
“Pending” )
DCChildhood Lead Poisoning Prevention Program. 202 -654-6036/6037202-481-3770
4
“Yes” ( “No” (
AAP Physical
Evaluation 2ndEd. (1997; AAP and EPSDT “No”
(
5
DC Universal Health Certificate Instructions (Amharic)
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6
1: –
D.C. Law 3-20, Immunization of School Students Act of 1979” DCMRTitle 22, 1( May) 2, 2008
“ ”
21,2
//
(DtaP/DTP
/DT)
(POLIO)
(Hib
77 )
(MM
R8 )
(9 )
(Varicella
9)
(Chicken
Pox)
B(H
epatitu
sB
10)
A(H
epatitu
sA1
11)
(Pen
umoccal
Con
juga
te12) (M
eni
ngoc
occal)
()
(Hum
anPa
pillo
maViru
s(H
PV)
2 0 0 0 0 0 1 0 0 0 02 – 3 1 1 1 0 0 1 0 1 0 04 – 5 2 2 2 0 0 2 0 2 0 06 – 11 3 3 2 / 3 0 0 3 0 3 0 012 – 14 3 3 3 / 4 1 1 3 1 4 0 015 – 23 4 3 3 / 4 1 1 3 1 4 0 024 – 47 4 3 3 / 4 1 1 3 2 4 0 048– 59 53 46 3 / 4 2 2 3 2 4 0 0
1, 1,2
//
(DtaP/DTP
/DT)
(POLIO
6 6)
(Hib)
(MMR7)
()
(Varicella
9 )(C
hicken
Pox)
B(H
epatitu
sB
10) A
(Hep
atitu
sA1
1 )
(Pen
umoccal
Con
juga
te))
(Me
ning
ococcal13
)
()
(Hum
an14
Papillo
maViru
s(H
PV)
( )
KÐ5 ( 5Ð10 ) 53, 4 4 0 2 2 3 2 0 0 06 – 12 ( 11Ð18+ ) 64, 5 4 0 2 2 3 2 0 1 3
1 (Spacing) 4
28
2 (Exemptions) 2)
Blood titers) 3)
3DTP/DTaP: (5) DTP/DTaP 4 4
DTP/DTaP 4 5 6
4Td/Tdap: 7 (3) Td 11 tetanus), diphtheriapertussis (Tdap) tetanus) diphtheria Tdap
Td 10
5Tdap: DTP/DTaP Tdap (1) 4 5
6 Polio) 4 IPV OPV 3
4 IPV/OPV
18 Polio)
7HIB: Hib 12
(1) 15 5
8MMR: 4
MMR Varicella 28
9Varicella: 4 12
12 3 13 2
Varicella (chicken pox)
10 Hepatitis B) monovalent hepatitis B DTaP-IPV-Hepatitis B, hepatitis B
24 8 monovalent hepatitis B 16
2 3 11-15 2 hepatitis B (Recombivax) 2 8
11Hepatitis A: (January) 1, 2005
12Pneumococcal: pneumococcal
24 59 1 5
13Meningococcal: 11
14HPV: papillomavirus (HPV) HPV
“ ”
2 D.C. Law 3-20& ACIP
3 blood titer)
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(DISTRICTOFCOLUMBIAUNIVERSAL HEALTHCERTIFICATE)
1: 1 5/ :
( .)
(PCP):
2: (Recommendations):(>3 yrs) `
x (>2 yrs) (BMI)%
HGB / HCT( Head Start )
20/ 20/ ______________________ ____________________
:
Under Rx) (Under Rx)
(Under Rx/
(Under Rx)
(Under Rx) (Under Rx)( 3 )
.
.
___________________________________________________________________________________
. (OTC)(
3:TB) - *
Tuberculin Skin Test(TST) :
TSTCXRCXR PCP
202-698-4040
*1 (LEAD TEST DATE:) 202-481-3770
4:
___________________________________________________________________________________________
MD/NP
5:
DC Universal Health Certificate (Amharic)
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(DISTRICT OF COLUMBIA UNIVERSAL HEALTH CERTIFICATE)
/ / ____/_____/________/ /Middle
1:
( )
Diphtheria,Tetanus, ( Pertussis (DTP,DTaP)
1 2 3 4 5
DT (7 yrs.)1 2 3 4 5
Tdap Booster)1
Haemophilus influenza ( ) Type b (Hib )1 2 3 4
(Hepatitis B) (HepB)1 2 3 4
Polio (IPV, OPV))1 2 3 4
Measles, Mumps, Rubella) (MMR)1 2
(Measles)1 2
(Mumps)1 2
(Rubella)1 2
(Varicella) 1 2
( )
(Pneumococcal Conjugate)1 2 3 4
A (HepA) ( 01/01/2005 )1 2
Meningococcal1
Human Papillomavirus (HPV)1 2 3
( ) (Influenza) (Recommended)1 2 3 4 5 6 7
Rotavirus) (Recommended)1 2 3
2:
( )
Diphtheria) (__) (__) Pertussis): (__) Hib: (__) HepB: (__) (__) (Measles): (__) (Mumps): (__)
(Rubella): (__) (Varicella): (__) Pneumococcal): (__) HepA: (_J) (Meningococcal:) (__) HPV: (__)
( ) ( ) ____/____/____.
3:
(
(Diphtheria) (__) (__) (Pertussis): (__) (Hib) (__) HepB: (__) (__) Measles): (__) Mumps): (__)
(Rubella (__) (Varicella): (__) (Pneumococcal): ( _) HepA: (__) (Meningococcal:) (__) HPV: (__)
___________________________________________ _____________________________________ ______________________
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( ) (District of Columbia Oral Health (Dental Provider) Assessment Form) (Amharic)
/ 1:
“ ” 2:
/ /
ONE CI TY
1: ( / ) (Last Name): (Middle Name): / / :
0 0 /
/ 1: 1: 0 0 0
/ 2: 2: 0 0 0
: :
: 0 - 0 - 0 0 0 ( ) (Primary Care Provider (Medical): /
:
0 0 0 0 2: / /
/
/ /
3: 4
3: ( )
Gingival inflammation ( ) (Y) , (N)
Plaque and/or calculus ( / ) (Y) , (N)
Abnormal gingival attachments ( (Y) , (N)
(Malocclusion) (Y) , (N)
Treated Dental Caries ( ) (Y) , (N)
Untreated dental caries ( ) (Y) , (N)
0
Sealants on permanent molars ( ) (Y) , (N)
Cleft lip and palate ( ) (Y) , (N)
Preventative services completed ( ) (Y) , (N)
?
0 Prophy 0 Fluoride 0 Oral Hygiene
4: / 0 0 0 0 0 0
0 0 0
DDS/DMD :
: :
((District of Columbia Health Certificate): Head Star ( ) (version) (AAPD) AAPD 6 3
(Portability) 1996 (Act of 1996 (HIPAA)) ( Family Education Rights and Privacy Act (FERPA))
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HUMAN PAPILLOMAVIRUS
(Genital) human papillomavirus (HPV)100 HPV
HPV (cervical cancer)
(upper respiratory tract) (warts) HPV
20 6 HPV50%
HPV 12,000
4,000
HPV70%
90% (genital warts) HPVHPV (genital warts) (cervical cancer)
(cervical cancer)
HPV 11-12 9HPV
HPV
HPV HPV
HPVvulvar cancer)
(genital warts) (anal cancer)
13-26 13-2126
HPV
1
2 1
3 1
yeast
D.C.
Department of Health Immunization Program (202) 576-9342 the Centers for
Disease Control and Prevention (CDC) 1-800-CDC-INFO (1-800-232-4636)
Updated January 2014 (SY 2014-15)
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GOVERNMENT OF THE DISTRICT OF COLUMBIA
Department of Health)
Human Papillomavirus (HPV)
1:
2: (18 HPV
1:
2009 17-10 (D.C. Law 17-10 (Human Papillomavirus Vaccinations and Reporting Act of2007) 6 11
1. Human Papillomavirus (HPV)
2. HPV
2:
Human Papillomavirus (HPV)
(to preteen) HPV(cervical cancer) (genital warts)
human papillomavirus` HPV HPV(genital warts)
HPV
______________________________________________________ ____________________________
( > 18
_______________________________________________________
(> 18
Updated January 2014 (SY 2014-15)
HPV Vaccination Opt-Out Certificate (Amharic)
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1200 Firs t Street, NE | Washington, DC 20002 | T 202.478.5738 | F 202.442.5024 | www.dcps.dc.gov
Office of Food and Nutrition
Services (OFNS) (Amharic)
(FARM)2014-15
75
(Community Eligibility Provision (CEP)) CEP
2014-15 FARM CEP
FARM
FARM
2014-15 FARM June) 2014 (July) 1, 2014CEP
(July) 1, 2014
1. ( CEP
2. e-form
3.
Office of Food and Nutrition Services 1200 First St. NE, 11thFloor, Washington, DC
20002
2013-14 (Sept.) 30, 2014
(Oct.) 1, 2014 CEP
Allergies) (Dietary Accommodations)
(“Students with Special Dietary Needs Form”)
1. ( (lactose)
2.
3.
4.
(Office of Food and Nutrition Services)
(“Reli-
gious/Philosophical Dietary Accommodations Application”) dcps.dc.gov/DCPS/Beyond+
the+Classroom/Food+Services/Food+Accommodations
(Office of Food and
Nutrition Services) [email protected], (202) 442-5112, dcps.dc.gov/DCPS/Beyond+
the+Classroom/Food+Services
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1200 First Street , NE | Washington, DC 20002 | T 202.478.5738 | F 202.442.5024 | www.dcps.dc.gov
Office of Food and NutritionServices (OFNS)
2014-2015(Students with Special Dietary Needs Form
School Year)
(IEP)(IEP)
( )
(disability) ?
(Allergies or Intolerances)
‘’
) (pureed )
/
( )
__________________________________ __________________________
__________________________________ __________________________
(Office of Food & Nutrition Services)
(Amharic)
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Notification of Rights Under FERPA (Amharic)
FERPA(The Family Educational Rights and Privacy Act (FERPA)) 18
(1) (DCPS) 45
(2) FERPA
(3) FERPA
FERPA
(thera-
pist) )
(4)
“ ” (“directory information”) FERPA
(i) www.dcps.dc.gov/enroll
“Release of Student Directory Information”
1200 First St. NE, 12th Floor, Washington, DC 20002
Office of Data and Accountability (ii) 30
(5) FERPAFERPA Family Policy Compliance Office, U.S. Department of Education, 400Maryland Ave. SW, Washington, DC 20202
1200 First Street, NE | Washington, DC 20002 | T 202.478-5738 | F 202.442.5024 | www.dcps.dc.gov