Book: I

Section: Instruction

Title: Verification of Private School Student Eligibility for Participation in Portland Public Schools Extra Curricular Activities

Code: IHBGC-E4

Status: Active

Adopted: February 3, 2015

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VERIFICATION OF PRIVATE SCHOOL STUDENT ELIGIBILITY

FOR PARTICIPATION IN PORTLAND PUBLIC SCHOOLS EXTRACURRICULAR ACTIVITIES

 

A separate application must be received for each activity in which participation is desired.  This form is used to verify eligibility and to approve/deny participation.

 

STUDENT INFORMATION

 

Student’s Name:

 

Student’s Date of Birth:

 

Grade in Private School:    

 

Student’s Address:  

 

Phone Number:

 

Parent/Guardian’s Name:

 

Private School Name:

 

Private School Address:

 

Private School Phone Number:

 

Private School Principal/Head’s Name:

 

Student is Applying for Participation in the Following Activity:

 

 

FOR EXTRACURRICULAR ACTIVITIES

 

_____ Written application received __________________________

                                                                                    (Date)

 

_____ Student’s written agreement to comply with behavioral, disciplinary, attendance and other rules applicable to all students in Portland Public Schools

 

_____ Sports physical (if applicable) performed on __________________; 

                                                                                                            (Date)

 

Cleared to play?  Yes/No

 

_____ Documentation of immunization presented 

 

_____ Documentation of insurance

 

_____ Documentation of age eligibility

 

_____ Documentation of academic standing (principals may ask to see grades or other      evidence that academic eligibility has been met)

 

_____ Student’s written agreement to abide by same transportation as regularly enrolled   students

 

_____ Student has completed tryout

 

_____ Student has been selected/not selected for the activity (circle one)

 

 

Decision by:  ______________________________________   Date:  _______________

                                    (Name and Title)

 

Student/parent notified of decision: 

 

Date:  ________________             Method: _________________________

 

 

IHBGC-E4 Verif of Priv Sch Std Eligibility for Part in PPS Extra-Curr Activities.pdf (9 KB)

 

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