PASSAIC COUNTY TECHNICAL INSTITUTE (Letterhead)

Transcription

1 (Letterhead) Date TO: DYFS Assigned Caseworker Attached are two (2) copies of the Child Abuse/Neglect Referral Forms from Passaic County Technical Institute. Please send one (1) copy of the form indicating the disposition of the case within two (2) weeks of receiving the referral. Should you wish to contact me regarding this case, my address and telephone number are provided below. Sincerely, Principal (or Designee) Printed Name Telephone Number

2 DYFS CHILD ABUSE/NEGLECT REFERRAL FORM Name of Student: Age and Grade of Student: Name and Address of Parent/Legal Guardian: Description of student s condition (including any available information concerning current or previous injuries, abuse, maltreatment and including any evidence of previous injuries): The nature and extent of student s injuries, abuse, or maltreatment: Any other pertinent information that the referrer believes may be relevant with respect to child abuse and to the identity of the alleged perpetrator: Name of Referring School Employee: Signature: Daytime Phone Number: Date: Name/Number of DYFS staff member contacted:

3 45 Reinhardt Road Wayne, New Jersey Telephone: (973) Dear Parent/Guardian: Date: has been placed on our BEDSIDE INSTRUCTION REGISTER effective. This means that has been removed from the regular student register and is not accumulating a record of absences. It is imperative that report to the School Nurse and Attendance Office before attending classes on the first day he/she returns to school so that he/she may be reentered into the regular student register as mandated by the laws of the State of New Jersey. Bedside instructor(s) will be contacting you to schedule appointments for home instruction. Please let us know if you have any questions concerning home instruction procedures. Sincerely, Guidance Counselor cc: Assistant Principal School Nurse s Office Attendance Office

4 GUIDELINES FOR HOME INSTRUCTION 1. Instruction shall be for no less than five (5) hours per week except when alterations in this schedule are recommended by the Child Study Team or school Medical Inspector. 2. Visitations may be made on weekends provided prior arrangements are made between the home instructor and parents/guardians. 3. Never tutor alone with a student. A parent, relative or other adult must be present. 4. Complete required time sheets and have them signed-off by the parent/guardian each time a visitation is completed. 5. Keep a brief log on school work completed during each session. Submit the summary to the guidance counselor at the conclusion of home instruction. 6. Submit time sheets and vouchers in a timely manner each month. 7. Home instructors are responsible for grading all assigned work. This includes marking assignments, tests, quizzes, etc. Grades must be computed for the time spent on homebound instruction even though a full marking period of work may not have been covered. 8. Department supervisors are responsible for securing textbooks and manuals for home instructors and teachers are responsible for getting materials and assignments to the home instructor through the Guidance Department. 9. In the event students are homebound for an entire marking period, the home instructor shall assign the grade for the quarter. He/she is responsible for submission of the grade to the assigned classroom instructor according to previously established timelines for grade entry, scanning and report card distribution (see attached chart of timelines). 10. When tutoring is completed, all textbooks, manuals, logs, etc. should be submitted to the classroom instructor. 11. A physician s note indicating the student s readiness to return must be submitted to the nurse s office prior to admission back to class if the student was on homebound due to medical reasons.

5 TO: Bedside Instructor(s) FROM: DATE: Thank you for agreeing to provide HOME INSTRUCTION for in the following subjects: PLEASE CONTACT THE STUDENT OR PARENT/GUARDIAN WITHIN TWENTY-FOUR (24) HOURS SO THAT THEY KNOW THIS SERVICE IS FORTHCOMING. Please remind the student that he/she must report to the School Nurse and the Attendance Office upon returning to school so that he/she may be re-entered into the school register and computer system. STUDENTADDRESS: STUDENT TELEPHONE:

6 BEDSIDE NOTICE TO: Homeroom Period 1 Period 2 Period 3 Period 4 Period 5 Period 6 Period 7 Period 8 Period 9 FROM: RE: BEDSIDE INSTRUCTION DATE: Please be advised that has been placed on BEDSIDE INSTRUCTION as of. He/she will be placed on the Bedside Instruction Register effective immediately and will not appear on your class roster until home instruction terminates. You will receive an ADD / DROP REPORT on the day the student is removed from the roster.

7 RETURN FROM BEDSIDE NOTICE DATE: Please be advised that has been removed from BEDSIDE INSTRUCTION as of. COUNSELOR: SCHOOL NURSE: GUIDANCE SECRETARY: EACH AREA LISTED BELOW MUST BE INITIALED: HOMEROOM TEACHER PERIOD TEACHER: THIS FORM MUST BE SIGNED BY THE ATTENDANCE OFFICER BEFORE RETURNING IT TO YOUR COUNSELOR: Attendance Officer ********************************************************************** THIS FORM MUST BE RETURNED TO THE APPROPRIATE COUNSELOR AT THE END OF THE SCHOOL DAY **********************************************************************