Student Signature Date. NOTE: Federal law requires the District to monitor online activities of minors. Staff Agreement and Responsibility – (Must be signed if working with students and the network) I understand and will abide by the Xxxxxxx County School District’s Acceptable Use Procedures for Network Access and Telephone Usage. I further understand that any violation of the regulations stated in this policy is unethical and may constitute a criminal offense. Should I commit any violation, my access privileges may be revoked, disciplinary action up to and including termination may be taken, and/or appropriate legal action may be pursued. I agree to promote the Acceptable Use Procedures with each of my students. I agree to instruct students on acceptable use of the network and proper network/telephone etiquette. During the times students are assigned to my care, I agree to direct students to acceptable network/telephone resources and monitor their use at all times. Neglect in my responsibility as an instructor could result in disciplinary action. Personnel Name (Please print): School Assignment: Job Title: Signature: Date: Xxxxxxx County Schools
Student Signature Date. Site Supervisor Agreement 1. Provide the student with a challenging and meaningful learning experience as outlined in the internship description. 2. Provide the student with any necessary training and supervision. 3. Communicate with the Career Center during the course of the internship when appropriate. 4. Complete the required two evaluations of the student’s performance (midway through and at the end of internship). 5. Reserve the right to discharge the student for just cause after consultation with Mount St. Mary’s University.
Student Signature Date. As the parent or legal guardian of the student signed above, I grant permission for the student to access networked services such as e-mail and the Internet. The District uses software to control access to objectionable material on the Internet and provides supervision of student computer use. However, I understand that some material accessed on the Internet may be objectionable. I accept responsibility for providing the student guidance on Internet access.
Student Signature Date. I am the parent or legal guardian of the Student, have read the complete document “Student Internship Agreement Form” and I am and will be legally responsible for the obligations and acts of the Student, and agree for myself and the Student to be bound by the terms of this Contract.
Student Signature Date. My son/daughter has discussed with me the tutoring component of the A+ Schools Program, and I give my permission for him/her to participate in the required tutoring activities. I understand that my son/daughter is responsible for his/her transportation to and from these activities.
Student Signature Date. Student’s payment obligation under this Contract shall continue notwithstanding any of the following:
Student Signature Date. For students who express a major difference of opinion regarding the results of this report, a supplemental statement may be attached to this report. Indicate if a supplemental statement is attached: YES NO I have reviewed the Final Field Learning Agreement I and have discussed all the content areas with the student intern. Field Instructor Signature Date Measurable Learning Behaviors/Activities
Student Signature Date. For the Site Supervisor I agree to supervise the activities listed on the reverse side. I will call XXXX Community Service Coordinator (382-1170) if the student does not arrive when expected. I will also call if any problems or questions arise concerning the student. I will complete an evaluation at the end of this project. Date Signature (Site Supervisor) Contact Info: email phone For Parents/Guardians I have read this agreement and agree that my daughter/son may carry out this Community Service project as part of her/his XXXX program. I give permission for her/him to travel to and from the Community Service site in the manner listed on the front of this form. Date Signature (Parent/Guardian) Contact Info: email phone For the Community Service Coordinator I agree to facilitate communication between the student, parent/guardian and site supervisor. I agree to keep the student informed of deadlines for submitting assignments and to grant credit upon completion of 30 or more hours. I will be available to help the student with any problems that arise. Date Signature (Community Service Coordinator)
Student Signature Date. Required If The User Is A Student: I have read this Authorization for Network/Internet Access. I understand that access is designed for educational purposes and that the District has taken precautions to eliminate controversial material. However, I also recognize it is impossible for the District to restrict access to all controversial and inappropriate materials. I will hold harmless the District, its employees, agents or Board members, for any harm caused by materials or software obtained via the network. I accept full responsibility for supervision if and when my child’s use is not in a school setting. I have discussed the terms of this Authorization with my child. I hereby request that my child be allowed access to the District’s Network/Internet. Parent/Guardian Name (please print) Date Parent/Guardian Signature Date
Student Signature Date. Dentist Agreement: I understand my obligation to supervise, direct and evaluate in his/her responsibilities as an EFDA in my practice. I agree to provide him/her with the opportunity to utilize his/her duties in a technical and professional capacity. I also understand and agree to attend and participate in at least one of the one-on-one classroom/laboratory sessions as a mentor.
