PELHAMM MIDDLLE SCHOOOL D Dr. Robert J. Roelle e, Principa al M Ms. Lynn M. Sabia, Assistant A Principal P

A August, 2016 D Dear Pelham Middle M Schoo ol Parents, IIt is with greaat enthusiasm that I welcom me all of our new n and returrning studentss and familiess to Pelham M Middle S School for thee 2016-17 sch hool year. As summer quickly comes to an end, I hoppe that you arre looking forrward to tthe start of thee new school year. It prom mises to be an exciting and pproductive exxperience for everyone at P Pelham M Middle Schoo ol. IIt is hard to beelieve only tw wo short montths ago, we saaid goodbye ffor the summer! During thhese two montths, the m middle schooll has been verry busy with several s summ mer academic programs in addition to ouur work to preepare for tthe new schoo ol year. T This summer, approximateely 85 of our students s contiinued their edducation at thee middle schoool during Jully and A August. Thirty y-six of our students attend ded the middlle school Sum mmer Institutee designed to provide addiitional ssupport in reaading, writing, and mathem matics. Twenty y-one studentts participatedd in a rigorouus two-week ccourse to pprepare them for joining ou ur accelerated d mathematicss program (A Algebra) offereed in eighth ggrade. Additionally, ssix students were w enrolled in our highly intensive, 12 20-hour Algebbra Institute inntended to prrovide studentts with tthe opportunitty to accelerate in high sch hool mathemaatics beginninng in ninth graade. Twenty--one of our sttudents aattended the Earth E Science “crash coursee” in August. Students whho took this coourse were abble to retake thhe Earth S Science Regen nts exam over the summerr. I am extrem mely proud off all of our stuudents who paarticipated in these cclasses during g the summer months! P Priorities forr 2016-17: E Each school year y is unique and this yearr promises to be successfull and fulfillinng for your chhildren. We haave eestablished seeveral school-wide and currriculum speciific priorities for our continued improveement: IInternationall Baccalaurea ate Middle Yeears Program mme T This year, Pellham Middle School will continue its journey towardds official dessignation as ann IB World S School ooffering the Middle M Years Programme. P D During the 20 015-16 schooll year, all of our o teachers participated p inn extensive prrofessional deevelopment thhrough w which they leaarned how to plan curricullum using the Middle Yearrs Programmee framework, worked on aligning tthe curriculum m across gradee levels and subjects, s explo ored strategiees in the areass of formativee assessment and ddifferentiated instruction, planned p inquirry-based lessons and autheentic, project--based assessments, and crreated rrubrics to morre accurately assess studen nt progress an nd communicaate with studeents and parennts about learrning ooutcomes. Teeachers at eveery subject an nd grade level implementedd Middle Yeaars Programm me lessons andd units in ttheir classroom ms, and studeents had the opportunity to participate inn a number off academicallly rich, high innterest uunits and projects. Our six xth grade stud dents experien nced foreign llanguage instrruction (incluuding our new west language, Man ndarin) and art a for the firstt time, and alll students enccountered moore interdiscipplinary, handss-on, and y-focused activities than ev ver before. Our O administraators and teacchers worked closely with our two internationally IIB consultantss throughout the t year, and we feel thoro oughly preparred to submit our applicatioon for authorrization to tthe Internation nal Baccalaurreate this Octo ober 1.

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During the coming year, our teachers will continue to move forward to improve teaching practice under the International Baccalaureate’s philosophy and curricular framework. In addition to planning their next set of Middle Years Programme units, teachers will strive to create assessments, criteria, and feedback measures that will be more standardized, precise, transparent, and holistic, the goal being to establish an assessment process that not only reports on student learning, but encourages it. We will also work to explore opportunities to incorporate additional community service and international mindedness into students’ experience. In the spring of 2017, Pelham Middle School will be visited by evaluators from the International Baccalaureate who will report on our progress. We are confident that - as a result of all of our hard work and that of our students - we will be approved as an IB World School, after which time we will be visited every five years so that our continued progress and improvement can be monitored by the IB. We are also excited to announce that our students’ Middle Years Programme experience will not be ending at the conclusion of eighth grade, Pelham Memorial High School has recently been designated as a “candidate school” by the IB, and high school teachers will now engage in the same work our middle school teachers experienced last year. It is our belief that this partnership between the two schools will lead to better communication and planning, a more thoroughly articulated curriculum, and a smoother transition for students as they move from eighth to ninth grade. For those who are new to Pelham Middle School or are not familiar with the International Baccalaureate Middle Years Programme, here are some answers to some common questions: What is “IB”? Founded in 1968, the International Baccalaureate (IB) is a non-profit educational foundation offering programs that help students develop the intellectual, personal, emotional, and social skills needed to live, learn, and work in a rapidly globalizing world. There are currently over 4,000 IB World Schools offering programs in over 140 countries around the globe. The IB offers a high quality curricular framework, professional development that supports effective educators, and a worldwide network of highly respected schools working together to share best practices. What is the “Middle Years Programme”? The Middle Years Programme (MYP) is a challenging curricular framework that encourages middle school age students to make practical connections between their studies and the real world, preparing them for success in further study and in life. The MYP framework comprises eight subject groups, providing a broad and balanced education for early adolescents. It is inclusive by design; students of all interests and academic abilities can benefit from their participation. The MYP aims to develop active learners and internationally-minded young people who can empathize with others and pursue lives of purpose and meaning. The programme empowers students to inquire into a wide range of issues and ideas of local, national and global significance. The result is young people who are creative, critical and reflective thinkers, well-prepared for the rigors of high school study and beyond. What is a “Candidate School”? Pelham Middle School is in the process of pursuing authorization as an IB World School. During this time, it is referred to as a “candidate school”. Throughout the candidacy phase, the IB organization provides a consultant to support teachers and administrators as they prepare their application and work towards authorization. We plan to submit our application for authorization on October 1, 2016, after which time we will participate in an authorization visit with two evaluators from the International Baccalaureate. These evaluators will interview teachers, students, parents, and administrators, observe classes, and examine our curriculum. After the authorization visit has taken place, the International Baccalaureate will decide whether we are ready to be authorized or if we have additional work to complete.

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What does this mean for my child? While we already have an excellent curriculum and outstanding teaching practices in place, we at Pelham Middle School believe firmly that students are best served through a process of continuous school improvement. The International Baccalaureate provides us with the framework, professional development, guidance, and global support network through which we can best achieve this valuable work. In general, students will experience additional interdisciplinary learning experiences, more opportunities for hands-on experimentation and openended problem solving, as well as discussion as to how we can bring classroom learning out into the community and view issues through a more global perspective. Overall, there will be a greater focus on inquiry, deep conceptual understanding, appreciation of others’ backgrounds and opinions, and a dedication to the IB Learner Profile (see enclosure). It is also important to recognize that the IB Middle Years Programme is for all Pelham Middle School students, not a select group. Every student will participate and benefit from the program. We are very excited about this process and hope you are as well! For more information about IB, visit www.ibo.org. For information on how the Middle Years Programme is impacting Pelham Middle School, visit our own IB webpage at ibpelham.weebly.com. If you have any additional questions, please feel free to call Sean Llewellyn, Supervisor of IB, at (914) 738-8190 Ext. 1117 or 914-633-6517. You can also email Sean at [email protected]. English Department For the 2016-2017 school year English teachers will continue to focus on creating inquiry-based units in the IB design that support the development of students who are risk-takers, principled, reflective, open-minded, and who possess the skills necessary to exceed the standards and achieve excellence. Over the summer months, teachers drafted an instructional spiral for the teaching of grammar structure and skills spiral for grades 6-8. This spiral will be refined over the next school year, and will serve as a guide for teaching and learning in the areas of language and structure. Research shows that the most effective way to expand student understanding of language and structure is to embed this instruction into the student writing process thereby placing the rules of grammar in context. English teachers will continue to teach clear, effective and concise written and oral communication which will now be spiraled and aligned both vertically and horizontally across grade levels. During the 2016-2017 school year, English teachers will explore and share best practices in grammar instruction. Last April a team from the Tri-State Consortium visited Pelham for three days to evaluate the K-12 writing program. The Tri-State Consortium is a consortium of high performing districts in the tri-state region who are committed to: external evaluation of programs, best practices, leadership, and professional development. The visiting team reviewed district-provided evidence of our work, observed classes and met with various constituency groups to get a better understanding of how writing instruction is supported and facilitated in all of the Pelham schools. The Consortium will provide the district with commendations and recommendations to consider. This constructive feedback will be presented, studied and prioritized by a district-wide Literacy Committee representing all constituencies. The visit, subsequent feedback and committee will support the goals of the strategic plan in terms of literacy curriculum, instruction and assessment as we strive for excellence for all of Pelham’s students. Social Studies Department Margaret Mead once said, "Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has." With this in mind, social studies teachers at the middle school continue to work to foster the growth of committed, principled and globally-minded citizens through teaching and learning. Social studies teachers in grades 6-8 have spent the last year aligning their instruction to new K-12 Common Core Social Studies Framework and Social Studies Practices (or skill requirements). This Framework, along with new assessments in grades 10 and 11, were developed by a group of educators from across the state to prepare our students for college, career and civic life through social studies courses that are rigorous and aligned to New York State Learning Standards. Social Studies practices such as historical context, geographic understanding, chronological sequencing, and participatory citizenship are identified, as well as the key ideas, “A National School of Excellence” 28 Franklin Place

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conceptual understandings and content specifications. During the 2016-2017 school year, social studies teachers will begin to utilize common acronyms and graphic organizers to support student comprehension and analysis of primary and secondary source documents. They also will continue to create inquiry-based units in the IB design which align organically with the new Framework and required social studies skills. Social Studies classes this fall will actively engage in Election 2016 activities. Teachers in grades 6-8 are creating activities and tasks focusing on the main issues of this election, the candidates, campaigning, voting trends, and party platforms. Along with classroom activities, Pelham students will participate in their very own mock election. All middle and high school students will vote in this mock election during their Social Studies classes and the results will be published on the school websites. This fall, as in years past, all 7th and 8th grade students will participate in the 2016 National Geographic Bee. Each year thousands of schools participate in the Bee using materials prepared by the National Geographic Society. This contest is designed to encourage the study of geography. Additionally, 8th grade students will act as historians as they conduct research, synthesize information, and then create a performance based project for the National History Day Contest. The theme of the 2017 NHD contest is “Taking a Stand in History.” We look forward to viewing the projects at the Museum Night scheduled for Thursday, January 26, 2017 at 6:30 PM in the Middle School Library. If you have any questions pertaining to the English or Social Studies Departments please contact the Director of Humanities, Mrs. Maria Thompson at [email protected] or call (914) 738-8110 x1108. Science and Mathematics The Pelham Middle School math and science departments are looking forward to expanding opportunities for all students to participate in the district’s STEAM (Science, Technology, Engineering, Arts, and Mathematics) initiatives. Our work in the upcoming year will focus on providing even more interdisciplinary experiences within math and science courses. It will also include an infusion of new inquiry based approaches as we align ourselves to new science and math standards. The groundwork for our adoption of new standards has been set by International Baccalaureate (IB) training and the instructional framework of the IB Middle Years Programme. Through its focus on real world applications and design thinking, students use important skills to collect information, draw conclusions, and propose solutions to authentic problems. Combined with an already strong emphasis on content, this helps prepare our students for life in a 21st century world. Our math teachers have designed units that expose students not only to theoretical math, but to the practical applications of math all around us. From using statistics to analyze a Rockland Boulders game to calculating rate in cross disciplinary math and science lessons, students are involved in problem based approaches to learning that engage them and facilitate intellectual growth. The science department’s initiatives also reflect an emphasis on practical applications of knowledge and skill. Our 7th graders will be taking an overnight trip to the Sharpe Reservation in May to participate in team building activities, study the environment, and use math to examine conservation issues. The 8th grade will study geography, geology, and even astronomy in October when they travel to the Frost Valley YMCA. Students will also participate in orienteering activities and team building workshops (which even includes a high-ropes course). We are also committed to providing STEAM experiences outside of the typical academic day. These offerings allow our students to explore their passions for science, technology, engineering, art, and math even after the last bell rings. From building robots to competing in Science Olympiad, we encourage every student to find an activity where they can create, explore, problem solve, or maybe just satisfy a curiosity they have always had.

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New York  10803 Phone: (914) 738-8190 (914) 738-8132

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New this year to our co-curricular offerings is a STEAM Research Club. Students will have the opportunity to investigate problems in areas ranging from psychology, math, and computer science to chemistry, physics, medicine, and environmental science. Participants will isolate a problem, collect data on that issue, and present their findings in a public forum. In keeping with our focus on design thinking and real world skill utilization, this new offering will supplement our ongoing work with the IB Middle Years’ Programme. If you have any questions about any of these programs, or others, please feel free to contact Dr. Thomas Callahan, Director of Mathematics and Science (K-12), at [email protected]. Technology Department Chromebooks - Grades 7 & 8 I am very happy to announce that Pelham Middle School will provide all 7th and 8th grade students with 24/7 access to World Wide Web resources. This year, each Pelham Middle School 7th and 8th grader will be issued a Google Chromebook for use at school and at home for the entire school year. The 2016/2017 school year marks our third year providing this program established during the 2014/2015 school year by the Pelham Education Foundation and New York State Senator Klein. Chromebooks are portable personal computers connected to the world-wide-web. These personal devices open up new opportunities for students while also allowing us to “manage” our student users. Over the past three years our 7th and 8th grade teachers have received at least three hours of hands-on training. Furthermore, thanks to the Pelham Education Foundation, further training opportunities exist for teachers as the year progresses. Faculty training focused on leveraging the educational benefits of the Google Apps for Education platform, which the Chromebook provides seamless access to. This is a very exciting initiative for our students and faculty! This year, students will receive their Chromebook during Physical Education classes. In order to receive the device students and parents must sign and agree to comply with the terms of the Chromebook Acceptable Use Policy and indicate if they choose to participate in the optional Chromebook Insurance Program. Once these forms have been signed and returned to school, students will be issued a Chromebook. Parents may view the Pelham Public Schools Parent/Student Data Privacy Right's Statement via our web page under the Parents and Community section. Design (Technology) Curriculum As our Technology teachers continue to implement the IB MYP Design program, they are constantly looking for ways to enhance their courses and remain ahead of the ever-changing world of instructional technology. In the spring of 2015, our teachers explored a variety of new resources for exposing students to new developments in technology. These new resources support new and improved modules of the program including in-depth coding, engineering, and design experiences. Our teachers were busy this summer adjusting courses to provide students with opportunities to explore these new technologies using a hands-on learning environment. An example of a new resource that will be explored can be viewed here at the Whitebox Learning website https://www.whiteboxlearning.com/applications/kidwind For more information about our Design curriculum, the Chromebook initiative or other technology questions, please contact our Director of Technology, Mr. Michael Tromblee at [email protected] Mindfulness Training In an effort to provide our faculty and staff with tools to support our students’ social and emotional development and establish highly respectful and supportive classroom environments, Pelham Middle School will host a full day Mindfulness training for all faculty and staff early in September. As children progress in their development through early adolescence, inevitably they will face new challenges. These challenges may come from any number of sources including school work, friends, family, changes in their physical development, busy schedules or even troubling world events. While these challenges are often seen as a normal part of growing up, for some students, the compounding impact of multiple challenges may lead to stress, anxiety or an undue amount of worry. One of our priorities at Pelham Middle School is for our students to maintain a healthy balance in their “A National School of Excellence” 28 Franklin Place

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lives and to experience positive social and emotional growth to complement their intellectual growth during their middle school years. It is our goal for our students to utilize research-based strategies for managing their attention, stress, anxiety and frustration while developing confidence, persistence, resilience and their ability to independently face challenges as they progress toward young adulthood. Parent Mindfulness workshops will be announced later this school year. Dignity for All Students Act (DASA) The Board of Education of the Pelham Public Schools, along with the administration, faculty, and staff of Pelham Middle School are committed to providing all students with a safe and productive learning environment. The school expects that all students and staff will conduct themselves in a manner that allows all students to focus on educational growth and healthy interpersonal development. If students choose to not allow others the opportunity to learn by harassing, hazing and/or bullying, students may be subject to disciplinary action as provided in the Pelham Board of Education Policy on Student conduct. Any student or parent who wishes to report violations of DASA may contact the middle school DASA Coordinator, Dr. Tricia Joseph at (914) 738-8190, ext. 1197 or any other member of the school faculty or administration. Parent/Teacher Conferences Here at Pelham Middle School, we believe the parent/teacher partnership is essential for supporting young adolescents through these critical, middle school years. We will continue to utilize the internet-based appointment booking system, Pick-a-Time to coordinate appointment times. Instructions on how to use Pick-aTime to schedule appointments will be sent to all parents in November. Teachers will be available for 7 minute conferences on the following days and times: December 7- 1:00-4:30, December 8- 1:00-3:00; 5:30-8:30, December 14- 8:15-12:00; 1:00-4:00; 5:30-8:30. Spring conferences will be made by invitation to the parents of students who are in need and will be scheduled as Team Meetings whenever possible. Spring conferences will occur on March 8-9 from 1:00-4:30 on both afternoons. We believe that in order to improve student performance, parent/teacher communication is critical. Individual conferences, phone calls, emails and team meetings are always available and may be initiated by parents, teachers, counselors or building administrators at various times during the school year. Opening Day Orientation Sessions On Thursday, September 8th we will be conducting orientation sessions for all grades (see below). The purpose of the orientation sessions is to familiarize our students with the facility, their teachers and their daily schedule. All students will receive their school schedule and other information at these sessions. Students will only attend school during the times indicated below. Grade 6 – 8:15 AM – 10:15 AM Grade 7 – 10:30 AM - 12:00 PM Grade 8 – 12:30 PM - 2:00 PM Middle School Bell Schedule The official start of the school day is 8:15 AM and the end of the school day is 2:51 PM. We also encourage all students to take advantage of our Academy Period, from 2:51 to 3:11 PM for help with homework and other academic needs. All of our teachers are available during the Academy Period, every day! Our library will have extended hours on Monday through Thursday starting Monday, September 12 until 4:00 PM. Eighth grade students taking Advanced Studio Art will begin their day at 7:32 AM, during Period 0. Please see the attached

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Pelham

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bell schedule and delayed opening schedule for the 2016-17 school year. Note: All delayed opening days end at 3:03 PM. New Staff Please join us in welcoming the following new staff members to the Pelham Middle School Community: Kevin Miller John Horan Andrew Van Bochove

Social Studies – Grade 7 Latin – Grades 6-12 Band Director/General Music – 6-12

Communication The middle school website will be updated and revised during the upcoming school year. The website is a valuable tool for parents and students for communicating with school personnel and for obtaining pertinent school information. The school calendar as well as our middle school policies and procedures are on our website. You are encouraged to review our policies and procedures with your children. Our food service has a link on our website. Please visit the food service website for more information. Most communications from the middle school will be sent as email blasts. Please be sure to keep us informed of changes to your email address and other contact information as necessary. Parents can also sign up to receive email alerts from the district by registering at https://visitor.r20.constantcontact.com/manage/optin?v=001vpPtPyii4Vr3ORNVtHdHGSV33N0f1L5ehIGImJvG 35X0TaQHi5HVw4F_4iWEA8hI8cAfH3aJszMkw_KTW52Tx9XF9lxyr9GW4bNSo2JO2uk%3D Middle School Clubs, Activities, Academic Competitions Pelham Middle School has many clubs, activities and competitions designed to offer students a variety of opportunities to become involved in school life, to explore and develop their interests and talents, and to contribute to the overall middle school program. While these activities are not required, our students are encouraged to participate. Activities offered may change year to year, based on student interest. The following is a list of extra-curricular and after-school activities. A full description of each club is available from our website and will be emailed out to parents in September. Clubs meet at different times throughout the year and are announced during morning announcements. For more information, including meeting dates and times please contact the advisor or check our website. Club/Activity/Competition 24 Math Club

Advisor Mr. Friel

[email protected]

8 Grade Mural Committee

Ms. Schwarz

[email protected]

Academic Triathlon

Ms. Kelly

[email protected]

American Math Competition 8

Dr. Callahan

[email protected]

Art Club

Ms. Schwarz

[email protected]

Chess and Strategy Club

Mr. Brown

[email protected]

Drama Club

Mr. Beck

[email protected]

Dungeons and Dragons Club

Mr. Brown

[email protected]

Forensics Speech Program

Mr. Beck

[email protected]

French Club

Mr. Avena

[email protected]

Living History Club

Mr. Acocella

[email protected]

Mandarin Club

Ms. He

[email protected]

th

“A National School of Excellence” 28 Franklin Place

Pelham

New York  10803 Phone: (914) 738-8190 (914) 738-8132

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Margaret’s Place

Ms. Charles

[email protected]

Math Olympiad

Ms. Vitale

[email protected]

Morning Basketball (7:15-8:00 AM)

Mr. Finegan

[email protected]

National Geographic Bee

Mrs. Thompson Ms. Rosenberg Ms. Pixley

[email protected] [email protected] [email protected]

Newspaper Club (Pelham Post) Pelham Cares / S.A.D.D (Students Against Destructive Decisions) Pelham Middle School G.O.

Mr. Brown

[email protected]

Mr. Acocella

[email protected]

Science Olympiad

Mr. DiBello

[email protected]

Scrabble Club

Mrs. DeVito

[email protected]

STEAM Research Club

Mrs. Buckley

[email protected]

Technology/Engineering/Robotics Club

Mr. LaGreca

[email protected]

Yearbook

Mrs. Salman

[email protected]

Interscholastic Athletics – Modified Sports Modified sports are offered to our 7th and 8th grade students. Modified athletics is the beginning of our athletic program and are the foundation of our JV and Varsity programs. Our students will begin to learn the importance of being a student-athlete and the dedication it takes to be part of a team. Modified teams are expected to practice Monday - Friday and games will be played on weekdays. All members of a team will play in each scheduled contest. Playing time may not be equal but everyone plays. To be eligible a student must have a valid physical and a completed green form. Sports that are offered in the fall season are boys & girls soccer, field hockey, football, boys & girls cross country, and volleyball. During the winter season, we offer boys & girls basketball and ice hockey. For the spring season, we offer baseball, softball, boys & girls track, and boys & girls lacrosse. The start dates will be Tuesday, 9/13 for the Fall, Monday, 11/28 for the Winter, and Monday, 3/27 for the Spring. Intramural Sports Starting this year, Pelham Middle School will offer a new intramural sports program for students in grades 7-8 as an alternative to our Modified Sports program. During the fall season, boys and girls soccer will be offered to interested students beginning during the week of September 19th and will end on October 28th. During the winter season, girls and boys basketball will begin during the week of December 8 and end on February 16th. Teams will play three times per week from 3:15 PM – 4:15 PM. Soccer games will be held at Glover Field. Important Upcoming Dates Thursday, September 1 Thursday, September 8 Friday, September 9 Monday, September 12 Thursday, September 22 Wednesday, September 28 Mon./Tues. October 3-4 Monday, October 10

Grade 6 “Bagels and Locks”, 10:30 AM – 12:30 PM Student orientation sessions First full day of school; Lunch program begins Extended Library hours begin (until 4:00 PM, M-Th) MS Back to School/Open House, 7:00 PM PTA Meeting, 7:00 PM No School – Rosh Hashanah No School – Columbus Day

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W Wednesday, October O 12 T Thurs./Fri., October 13/14 F Friday, Octob ber 14 M Mon-Wed, Occt. 17-19 T Tuesday, Octo ober 18 F Friday, Octob ber 28

No Schoo ol – Yom Kip ppur Yearbook k Picture Day ys Grade 6 – Friday Nigh ht Live Dancee, 7-9 PM Grade 8 – Frost Valley y Overnight T Trip 2 Hour Delay D (10:15 start s time) G.O. Dan nce (Grades 7 & 8), 7-9 PM M

I truly believee that successfful schools arre built upon strong s partnerrships betweeen and amongg all memberss of the sschool commu unity. We aree very fortunaate in Pelham to have a wonnderful facility, outstandinng teachers annd staff, ssupportive parrents and greaat students. To T this end, I look l forward to working cllosely with yoou and your cchildren aas we work to ogether to con ntinue the trad dition of excellence at Pelhham Middle S School. S Sincerely,

R Robert J. Roelle, Ed.D. P Principal

ational Sc chool of E Excellenc ce” “A Na 28 Frankl lin Place

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New York  10803 3 Phone: (914) 738 8-8190 (914 4) 738-8132 2

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ATTENDANCE PROCEDURES\POLICIES

ABSENCES The Pelham School District believes regularity of attendance and punctuality are important for children, and that high levels of learning take place when students attend school on a regular basis. The district believes that students, parents and the district should work together to assure that each student develops an appropriate understanding and attitude regarding his/her obligation to attend school daily except when a legal (excused) absence prevents such attendance. New York State Education Law requires that all pupils be in school during all days and hours that school is in session. It also specifies the following as samples of legal (excused) reasons for pupil absences: 1. Personal illness or illness of a member of the family that requires the student remains at home to assist. 2. Death in the immediate family. 3. Required court presence. 4. Required discharge of religious obligation. The following attendance procedures should be observed: All absences must be verified by a parent or guardian by phone contact and a note. On the day that a student is absent, a parental phone call should be made by 8:00 a.m. to the Middle School Attendance Office (738-8190). Upon returning to school, the student must bring in a written excuse, giving the date and reason for the absence, signed by the student’s parent/guardian. This note should be brought to the middle school office before classes begin.  If a student is absent for any reason during the school day, he/she will not be permitted to participate/attend any after school activities or functions. (athletic events, dances, etc.)

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EARLY DISMISSAL Notes for early dismissal (or phone calls) must be presented to the Attendance Office upon arrival at school. Middle School students may not leave campus at any time unless they are signed out and accompanied by a parent or guardian.

TARDINESS Pelham Middle School Students are expected to arrive at school on time. Students arriving late must report directly to the Middle School office upon arrival and have a note from his/her parent(s) stating the reason for arriving late. Students arriving late to any class during the school day must have a pass. Students who are continually late for class (unexcused lateness) are subject to disciplinary action. TRUANCY Truancy is absence from school without prior knowledge and prior consent of the student’s parent or guardian. Truancy will result in disciplinary action. Truancy is an illegal absence from school. Students should not expect the opportunity to submit assignments late if they were due on the day of truancy. Students should not expect to be able to make-up exams, presentations, etc. that were scheduled on the day of the truancy.

PELHAM MIDDLE SCHOOL Dr. Robert J. Roelle, Principal Ms. Lynn M. Sabia, Assistant Principal

August, 2016 Dear Parents, As many of you are aware, for the past 10 years, Pelham Middle School has been the fortunate recipient of Margaret’s Place, partially funded by the Joe Torre Safe at Home Foundation and administered by Westchester Jewish Community Services (WJCS). WJCS administers four Margaret’s Place programs in Westchester school districts as part of a national network of 11 program sites. Margaret’s Place provides education and support services across the school community to prevent interpersonal violence, intervene in the cycle of domestic violence and promote healthy relationships in the lives of youth. Margaret’s Place staffs a “safe room” for students to talk issues in their lives with each other and a professional counselor. Margaret’s Place delivers violence prevention curricula; provides workshops to students, school staff, parents and community; and offers daily group and individual counseling. Margaret’s Place curriculum and workshops provide a variety of topics to promote respect and acceptance across our school community; build awareness of violence and prevention; and build skills that promote healthy relationships with peers and adults. Lessons are delivered in all three grades, offering a layered approach to helping our children build healthy relationships and healthy communication skills. The 6th grade lessons are a brief overview of acceptance and respect for others with an emphasis on bullying prevention. In 7th grade, lessons are delivered throughout the year (between 9-11) with topics including Violence Awareness and Prevention, Coping and Safety Strategies, Bullying and Cyber Bullying, highlighting respect for diversity of race, religion, class, gender and sexual identity, Communication Skills, Resilience and Healthy Self-Advocacy/Empowerment. In 8th grade, several lessons on Healthy Dating and Teen Dating Violence Prevention are provided. The purpose of the 8th grade lessons is to help students develop a better understanding of positive and respectful aspects of relationships as well as to recognize abuse and the role that power and control plays in these relationships. All teaching is delivered through a combination of lectures, discussion, literature, class activities, current events and media. In the 8th grade, some of the important and powerful educational media has mature themes and provocative language which is processed with the students. Sharon Charles, LCSW has been the Coordinator of the Margaret’s Place Program since its inception at Pelham in 2006. Sharon would like to express her gratitude and appreciation to the Pelham community. She thoroughly enjoys working with all of your children and helping Pelham work toward achieving the strategic goal of fostering the social and emotional growth of the students of Pelham. Sharon also delivers workshops and offers counseling and support groups throughout the year to parents and families. Should you need any assistance or have any questions, please feel free to call Sharon at 632-4717 or email her at [email protected]. Sincerely,

Robert J. Roelle, Ed.D. Principal Pelham Middle School

“A National School of Excellence” 28 Franklin Place



Pelham 

 New York  10803 Fax: (914) 738-8132



Phone: (914) 738-8190

PELHAM MIDDLE SCHOOL Dr. Robert J. Roelle, Principal Ms. Lynn M. Sabia, Assistant Principal

Summer 2016 Dear Parents, Pelham Middle School, along with 39 other secondary schools in Westchester County, is continuing a Student Assistance/Project SUCCESS Program for the 2016-2017 school year. This program is funded by the NYS Office of Alcoholism and Substance Abuse Services through the Westchester County Department of Community Mental Health, the school district, and by corporate and private donations. The program will provide alcohol, tobacco, and other drug prevention, education, and counseling services to students including early identification of students experiencing, or at high risk for, substance related problems, and students involved in bullying situations and problem gambling. It is anticipated that this combination of services will accomplish the following goals: 1. prevent the development and reduce the incidence of alcohol, tobacco, and other drug use or related problems 2. improve school performance and attitudes toward school among program participants Cristina Konior will serve as Pelham Middle School’s Student Assistance Counselor. She will be working full time in the district and have evening hours available to meet with parents and community groups. Ms. Konior has a Masters Degree in Mental Health Counseling, previous experience working with adolescents, and specialized training in prevention and early intervention strategies with adolescents at risk of having substance or gambling related problems. She is being paid and supervised by Student Assistance Services Corporation and the school. Ms. Konior will be meeting with 7th and 8th grade students individually and in small groups for education and prevention activities to correct erroneous perceptions about substance use and to teach students skills to identify and resist social and situational pressures to use substances. Parent meetings corresponding to our prevention program will also be offered. Ms. Konior will be available to see students who are using substances, gambling or have personal, peer, school, or family issues that could increase their risk of using substances including involvement in bullying situations. If you would like to speak to the Student Assistance Counselor about your child or another student, please call her directly at 738-8182. All calls will be confidential. If your child is referred and/or refers him/herself and you do NOT want your child to meet with the Student Assistance Counselor, please complete the form at the bottom of this letter and return it to me. We are hopeful that this program will show promising results. Data will be collected to assess the overall effectiveness of the program in preventing and reducing risk factors for alcohol, tobacco, other drug use, and problem gambling. Please feel free to call me if you have any questions about the program. Sincerely, Robert J. Roelle, Ed.D. Principal Safety Tip: Please monitor the use and storage of all prescription and non prescription medications in your home to reduce misuse by youth. Unused medications can be returned at Mount Vernon Police Department, 2 Roosevelt Square No., City Hall, Mt. Vernon, NY 10550, 914-665-2500 or Eastchester Police Department, 40 Mill Road, Eastchester, NY 10709, 914-961-3464. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Please return to the Principal only if you DO NOT want your child to be seen by the Student Assistance Counselor. Name of Student: _______________________________________________________________ Grade: _________ Address: ________________________________________________________ Phone: __________________ If my child is referred and/or refers him/herself to the Student Assistance/Project SUCCESS Counselor, I do not want him/her to meet with the Student Assistance/Project SUCCESS Counselor for individual or group counseling. _____________________________________ Signature of Parent/Guardian

__________________ Date

PELHAM MIDDLE SCHOOL Dr. Robert J. Roelle, Principal Ms. Lynn M. Sabia, Assistant Principal VERANO DE 2016 Estimados padres, Pelham Middle School junto con 39 otras escuelas secundarias en el condado de Westchester y Rockland, continuará el Programa de Asistencia Estudiantil/Proyecto SUCCESS durante el año escolar de 2016-2017. Este programa es fundado por la Oficina de Alcoholismo y Servicios de Abuso de Sustancias del estado de Nueva York, a través del Departamento de Salud Mental Comunitario del condado de Westchester, del Distrito Escolar y de donaciones corporativas y privadas. El programa enseñará a los estudiantes actividades de prevención del consumo de alcohol, tabaco y otras drogas; igualmente, ofrecerá servicios consejeros. Además este programa facilitará la intervención temprana en los estudiantes quienes tienen problemas relacionados con alcohol y otras drogas. Incluso, el programa ayudará a los estudiantes que pudieran estar involucrados en situaciones de intimidación escolar y en problemas de adicción al juego. Esperemos que la combinación de estos servicios logren los siguientes objetivos: 1. Prevenir el consumo de alcohol, tabaco y el abuso de otras drogas entre los estudiantes. 2.

Mejorar los trabajos académicos y las actitudes hacia la escuela entre los participantes del programa.

Christina Konior servirá como consejero de Pelham Middle School’s Asistencia al Estudiante. Ella va a trabajar a tiempo completo y tendrá horas por la noche para reunirse con los padres y con los grupos comunitarios. La Sra. Konior tiene una Maestría en trabajo social, Experiencia previa experiencia trabajando con adolescentes y es especializado(a) en estrategias de prevención e intervención temprana con adolescentes en riesgo de desarrollar problemas de alcohol, otras drogas o de adicción al juego. Ella el salario y la supervisión de vendrá de la Corporación de Servicios de Ayuda al Estudiante y de la escuela. La Sra. Konior se reunirá con los estudiantes individualmente o en pequeños grupos para realizar actividades de educación y prevención con el objetivo de corregir percepciones erróneas sobre el uso de sustancias y para enseñar como los estudiantes pueden identificar y resistir influencias sociales y situaciones perteneciendo al uso de drogas y alcohol. Este programa también ofrecerá reuniones para los padres. Asimismo. La Sra. Konior estará disponible para reunirse con los estudiantes quienes consumen alcohol y otras drogas, quienes son adictos al juego, quienes tienen problemas personales y los que tienen problemas en la escuela relacionados a la intimidación escolar. Si usted está preocupado por su hijo o por otro estudiante y le gustaría hablar con el consejero para ayudar al estudiante, y/o quisiera que ella se reuniera con su hijo o otro estudiante, por favor llámela directamente al 738-8182. Todas las llamadas serán confidenciales. Si su hijo se refiere a ella mismo/a y no quieres que su hijo se reúna con el consejero, por favor llene el formulario al final de a esta carta y devuélvalo a la oficina. Esperemos que la participación de estudiantes en este programa resulte en efectos positivos para sus hijos. Para evaluar el progreso general del programa, la información será acumulada y evaluada sobre la prevención y reducción del uso de alcohol, tabaco, otras drogas y adición al juego. Por favor contáctenos si tiene alguna pregunta acerca del programa. Sinceramente, Robert J. Roelle, Ed.D. Principal Advertencia de seguridad: Por favor controle el uso y almacenamiento de todos los medicamentos recetados y no recetados en su casa para reducir el uso entre los jóvenes. Pueden devolver medicaciones que no han usad o a Mount Vernon Police Department, 2 Roosevelt Square No., City Hall, Mt. Vernon, NY 10550, 914-665-2500 or Eastchester Police Department, 40 Mill Road, Eastchester, NY 10709, 914-961-3464. -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Por favor devuelva este formulario al Director, si usted NO desea que su hijo se reúne con el consejero de [Asistencia Estudiantil/Proyecto SUCCESS] Nombre del estudiante: ___________________________________________________________ Grado: _________ Dirección: _____________________________________________________ Teléfono: ____________________ Si mi hijo se refiere el mismo y/o alguien lo refiere, al consejero de Asistencia Estudiantil/Proyecto SUCCESS, yo no quiero que se reúne con él/ella para consejería individual o en grupo. _____________________________________ __________________ Firma del padre/tutor Fecha

Nuevos maestros, nuevos útiles escolares, nueva ropa, nuevos amigos, nuevas tensiones. Una nueva oportunidad de hablar con su adolescente.

Cuando sus hijos regresan a la escuela, hay sentimientos de entusiasmo y nuevas oportunidades esperándolos. Pero a la misma vez, cuando los adolescentes empiezan un año nuevo, pueden sentirse estresados y ansiosos. Como padres, deben aprenden cómo hablar con su adolescente sobre esta situación para que sus hijos pueden sentirse seguros si se enfrenten con una situación difícil. Visita a nuestra pagina web, PoderParaLosPadres.org donde pueden encontrar unas sugerencias.

New teachers, new supplies, new clothes, new friends, new pressures. New opportunity to talk to your teen.

Back to school is an exciting time filled with new opportunities. But for many teens the start of the new year can also be filled with stress,anxiety, and the pressure to fit in. Learn how to talk to your teen about coping with these things safely at www.PowerToTheParent.org.

PELHAM MIDDLE SCHOOL BELL SCHEDULES 2016-2017 PERIOD

TIME 7:32-8:12 8:15-8:59* 9:02-9:43 9:46-10:27 10:30-11:11 11:14-11:55 11:58-12:39 12:42-1:23 1:26-2:07 2:10-2:51 2:51-3:11

PERIOD 0 PERIOD 1 *HOMEROOM 8:56-8:59 PERIOD 2 PERIOD 3 PERIOD 4 PERIOD 5 PERIOD 6 PERIOD 7 PERIOD 8 PERIOD 9 Academy Period

DATE CYCLE DAY TIME 7:32-8:12 8:15-8:59* 9:02-9:43 9:46-10-27 10:30-11:11 11:14-11:55 *Includes Homeroom

Nov. 23 Day 2 PERIOD 0 6 7 8 9 1

Early Release Schedule Dec. 7 Dec. 8 Day 4 Day 5 PERIOD PERIOD 0 0 1 5 2 6 3 7 4 8 5 9

March 8 Day 2 PERIOD 0 2 3 4 8 9

March 9 Day 3 PERIOD 0 1 2 3 4 7

Staff Development Delayed Opening Schedule (Oct. 18, Nov. 15, Jan. 13, Feb. 13, Mar. 20, Apr. 25, May 18, June 1 ) TIME PERIOD LENGTH 9:45-10:12 0 27 min 10:15-10:44 1 29 min 10:44-10:47 Homeroom 3 min 10:50-11:19 2 29 min 11:22-11:51 3 29 min 11:54-12:23 4 29 min 12:26-12:55 5 29 min 12:58-1:27 6 29 min 1:30-1:59 7 29 min 2:02-2:31 8 29 min 2:34-3:03 9 29 min 3:03-3:11 Academy Period 8 min

TIME 10:15-10:44 10:44-10:47 10:50-11:19 11:22-11:51 11:54-12:23 12:26-12:55 12:58-1:27 1:30-1:59 2:02-2:31 2:34-3:03 3:03-3:11

Inclement Weather Delayed Opening Schedule (NO PERIOD 0 CLASSES) PERIOD 1 Homeroom 2 3 4 5 6 7 8 9 Academy Period

LENGTH 29 min 3 min 29 min 29 min 29 min 29 min 29 min 29 min 29 min 29 min 8 min

2016‐2017 Pelham Middle School PTA Membership Drive and Directory  Enrollment  Hello Pelham Middle School Families,     We have exciting news about this year's PTA membership drive and directory! We are launching our  new online membership and directory system with MySchoolAnywhere.com.     Beginning on August 15th, 2016 all middle school families may go online  to join.myschoolanywhere.com and enter our unique school code PMSPTA or use the following  link https://www.myschoolanywhere.com/volunteer‐new.a5w?vol=PelhamMiddleSchool95948 to enter  and verify their contact details.     On the MySchoolAnywhere site you will also be able to purchase your 2016‐2017 PTA and SEPTA  memberships. All PTA memberships include 24/7 online directory access and at least one published copy  of the middle school directory. You may purchase additional published hard copies of the directory  through the online store (in addition to other nifty Pelham Middle School booster items!). We plan to  have directories printed and distributed in early October.    All families will have the opportunity to set their individual privacy settings and opt in or out of visibility  in both the online and published directories. MySchoolAnywhere is a fantastic resource and is FERPA  compliant. Parent and student contact information will NEVER be shared with anyone for any reason  outside of school‐related events, and use of directory information for marketing purposes is strictly  forbidden. We appreciate your support in this endeavor.     Beginning on August 15th, we hope you will visit MySchoolAnywhere, to join the PTA and join us in  supporting our wonderful school! We will send out a reminder email and additional invitations to join  the Middle School PTA via MySchoolAnywhere. We will also be at the PMS Open House to help parents  with either using the MySchoolAnywhere site or updating directory information/joining the PTA via  offline means. Please email [email protected] with any questions.      Thank you,  The Pelham Middle School PTA Membership & Directory Team  

PELHAM PUBLIC SCHOOLS 2016-2017 CALENDAR SEPTEMBER M

17+2

T

5

W

6

Th

F

1

2

7

8

9

5

Labor Day

6-7

Superintendent's Conference Day

8

Schools Open

13

2 Hour Delay Staff Development

20-24

FEBRUARY

Presidents’ Day and Winter Recess

M

T

6

7

15 W

Th

F

1

2

3

8

9

10

12

13

14

15

16

13

14

15

16

17

19

20

21

22

23

20

21

22

23

24

26

27

28

29

30

27

28

Th

F

OCTOBER

17

M

T

W

Th

F

3

4

5

6

7

10

11

12

13

14

17

18

19

20

21

24

25

26

27

28

3-4

Rosh Hashanah & Observance

8, 9

10

Columbus Day

20

12

Yom Kippur

18

2 Hour Delay Staff Development

Parent/Teacher Conferences (K-12)

MARCH

2 Hour Delay Staff Development

31

NOVEMBER M

19

T

W

Th

F

1

2

3

4

7

8

9

10

11

14

15

16

17

18

21

22

23

24

25

28

29

30

DECEMBER M

T

16+1 W

Th

F

1

2 9

5

6

7

8

12

13

14

15

16

19

20

21

22

23

26

27

28

29

30

JANUARY

20+1

M

T

W

Th

F

2

3

4

5

6

9

10

11

12

13

16

17

18

19

20

23

24

25

26

27

30

31

11

Veterans' Day

15

2 Hour Delay Staff Development

23

Early Release

24-25

Thanksgiving Day and Recess

7

10-14

30

31

T

W

Th

F

APRIL

15

17

18

19

20

21

24

25

26

27

28

M

T

W

Th

F

1

2

3

4

5

8

9

10

11

12

15

16

17

18

19

22

23

24

25

26

29

30

31

M

T

W

Th

F

1

2

5

6

7

8

9

12

13

14

15

16

19

20

21

22

23

26

27

28

29

30

2 Hour Delay Staff Development

MAY

Memorial Day

Regents

23

Regents Rating Day/Last Day of School

24

Graduation

2 Hour Delay Staff Development

The calendar allows for four snow days before it would be necessary to take back vacation days. If it is necessary to make up school days due to closings for inclement weather, etc., the days will occur in this order: April 12, April 13, February 24, February 23

22

JUNE

Martin Luther King, Jr. Day

See electronic calendar at pelhamschools.org for most recent information.

29

7

14-22

Early Release

28

14

Superintendent's Conf. Day

*Tentative

24

27

6

1

No Students / Staff Attendance Required

Student Two Hour Delay - Staff Development

17

23

13

New Year’s/Final Day of Kwanzaa and Hanukkah

No Students / Staff Attendance Required

16

22

5

Kwanzaa

Parent/Teacher Conferences

15

21

12

26-31

Superintendent’s Conference Day:

14

20

4

Hanukkah

Schools Closed

13

11

24-31

Key

10

3

Christmas Day and Holiday Recess

16

9

10

25-31

2 Hour Delay Staff Development

3

8

2 Hour Delay Staff Development

29

Schools Open

2

7

25

Parent/Teacher Conferences (K-12)

13

1 6

Passover (Begins at sundown)

8, 14

3

W

10

18

2

T

M

Parent/Teacher Conferences (6-12)

1

Spring Recess and Good Friday

23

M

17

TOTAL DAYS Students:

181

Teachers:

185

Adopted: March 29, 2016 Revised: July 1, 2016

Pelham Public Schools 2016-17 PHOTO AND PUBLICITY RESTRICTION FORM ONLY IF YOU DO NOT GRANT PERMISSION for the District to share your child’s photo or work, please sign and return. The Pelham Pubic School District often publishes photographs and videos of students and their work on its website, the Internet, in the District newsletter, and through local print, online, and broadcast media. If you give permission to the school district to use your child’s photo or work in the aforementioned ways, you do not have to do anything with this form. If you do not grant permission to the school district to use your child’s photo or work on its website, the Internet, in the District newsletter, and through local print, online, and broadcast media, you must complete and return the form below to the main office in your child’s building by Friday, Sept. 9, 2016. Please note:  If you do not grant permission, a separate form must be submitted for each child.  This restriction form does not pertain to photographs or stories of students who are part of athletic teams or performing with musical and drama groups within the District. It should be assumed that through participation in these activities, your child may be photographed.  At no time are students with special learning needs identified as such without prior permission from parents. If you have questions, please contact Maria Slippen in the District Office 914-738-3434 x1131 or [email protected]

--------------------------------------------------------------------------------------------------------------------I DO NOT WANT my child photographed or videoed for school-related stories for the forums listed above, nor do I want their work to appear in publications as described in this letter. Student Name: ________________________________________________________________________ School:

________________________________________________________________________

Grade:

________________________________________________________________________

Teacher:

________________________________________________________________________

Parent Signature:

_______________________________________________________________________

FOOD SERVICES FOR 2016-17 WHITSONS CULINARY GROUP Pelham Public Schools welcomes back Whitsons as our food service provider. Breakfast and lunch are offered daily at all of our schools. Visit your child’s school website for a link to menus.

NUTRIKIDS ACCOUNT FOR MEAL PAYMENTS We utilize the Nutrikids Point of Sale System which allows students to charge their meals to their Nutrikids account. You can fund your child’s Nutrikids account in one of two ways: 1. My School Bucks—an online payment solution at www.myschoolbucks.com. Set up your student’s account using your child’s name and birthdate. Existing accounts have the same log-in information.     

Set up automatic recurring payments or automatically add money to a student's account only when the balance runs low. Make deposits to multiple accounts with a single transaction. Receive low balance email notifications (you must set this up). View purchases for the past 90 days. Balances carry forward to the next school year.

2. OR-Write a Check—payable to Pelham Cafeteria Fund with the student’s full name in the memo field. REMINDER—Every student has a Nutrikids account. See the attached page for account rules. If you don’t want your child incurring charges through Nutrikids, please complete the attached opt-out form.

See Reverse for USDA Non-Discrimination Statement

MARY MILLS— Director of Dining Services 738-8110 x1184 [email protected]

FREE AND REDUCED MEAL APPLICATION FORMS ATTACHED REMINDER NEW APPLICATIONS must be filed every year. Please complete an application EVEN IF your student was approved last year.

MEAL PRICING Elementary Schools Breakfast $1.50 Lunch

$2.75

Middle and High Schools Breakfast $2.50 Lunch

$3.25

USDA NON-DISCRIMINATION STATEMENT In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: [email protected]. This institution is an equal opportunity provider.

NUTRIKIDS Point of Sale Meal Charge System Account Rules and Opt-Out Form What is a Nutrikids Account?

All students attending Pelham schools have an account in Nutrikids which allows them to charge their meal purchases to an account.

What if I want to opt my student out?

Please complete the bottom of this form for each student. Please note that once disabled, your student will only be able to purchase food with cash. Opting out does not excuse any existing negative balance. The negative balance must be paid before the account can be disabled.

How do I make payments on the account?

Deposits to student accounts should be made online at www.myschoolbucks.com or by check made payable to Pelham Cafeteria Fund. On the schoolbucks site, parents can set up balance alerts and track their child’s purchases.

What happens if the balance is negative?

When a student attains a negative balance, the Whitsons’ staff will notify the parent, via email, phone call or note from the cashier, to request deposit of funds to bring the account current.

What happens if the balance reaches -$10? If the balance becomes greater than -$10.00 the Nutrikids account for that student will be frozen, thus requiring students to pay in cash for any further purchases. A student with a frozen account will receive an emergency meal consisting of a cheese sandwich on whole wheat bread with low fat white milk, vegetable and a cup of fruit. The child will also be charged for this meal. Once sufficient funds are added to the account, the student will be permitted to use the Nutrikids account for further purchases. What happens to account balances at the end of the school year?

Account balances carry forward to the next school year. The Whitsons’ staff will notify parents of a negative balance. Negative balances are expected to be paid in full.

What if my student receives free or reduced lunch?

Students that qualify for free or reduced meals are required to use the Nutrikids account to receive their meals.

Return to: Whitsons Food Service Director | Lunch Office | Pelham High School | 575 Colonial Ave., Pelham, NY 10803

I, ___________________________, parent or guardian of __________________________________ do not wish to participate in the Nutrikids meal program. I understand that my child must pay cash for meals and in the event of emergency will have to contact me and will not be allowed to charge a meal. I also understand that if I apply and qualify for free/reduced meals my child will be required to have an active, enabled account. Date: ______________________ Signature of Parent/Guardian:_____________________________ Student ID Number: _______________________________________________________________ Student School: __________________________________________________________________ **Please note: Every child is enrolled yearly and the opt-out must be sent in yearly.

See Reverse for USDA Non-Discrimination Statement

USDA NON-DISCRIMINATION STATEMENT In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: [email protected]. This institution is an equal opportunity provider.

August 2016 Dear Parents: Whitsons School Nutrition is pleased to renew our partnership with Pelham Schools. We are excited to be able to provide a great tasting, nutritious school dining program that meets Healthy Hunger Free Kids Act guidelines and engages students in developing a positive “fooditude.” Whitsons educational dining programs boast menus that are delicious and highly appealing to young people. Yet, at the same time, we provide the wholesome foods so important to nurturing the health of growing bodies at every stage of development. We know that students need to be at their best physically to meet the academic challenges they face each day. Our chefs use wholesome ingredients to freshly prepare our food, paying particular attention to the use of whole grains, fresh fruits and vegetables, lean meats and healthy snacks. We work hand in hand with the school community to develop menus that focus on quality and variety, while also maximizing nutritional value and ensuring adherence to national, state, and local health and wellness guidelines.

Elementary Schools At the elementary schools, we will offer breakfast items, a hot lunch entree and salad, bagel, grilled cheese and yogurt lunch alternatives every day. A la carte offerings will be limited to wholesome choices such as fresh fruits and vegetables, yogurt, and carefully approved snacks. It is our mission to help your children learn to eat and enjoy healthy foods. Our entrees include whole wheat and whole grain bread/buns/ bagels/pizza crust. Whole grain pasta and brown rice are also primary offerings. All our offerings contain Zero Trans Fats. We are committed to reducing or eliminating all unnecessary food additives from your children’s meals. At this level, our award-winning Nutrition Safari® program will introduce your children to lovable animal characters to teach them about selecting healthy choices from each different food group for a well-balanced diet. The program’s mission is to increase participation in the National School Lunch Program (NSLP) and the National School Breakfast Program [NSBP] and encourage students to develop lifelong healthy eating habits. As part of Nutrition Safari Pelham Schools will receive: •

Annual Spokes animal Visit

•

Nutritional Menus

•

Monthly Nutrition Theme Day

•

Posters with Nutritional Messages

•

Monthly Activity Sheet

Secondary Schools For the secondary schools, our Smart Choices TM nutrition education program will provide the following features: •

Smart Choices Menu Items

•

Monthly Newsletter

•

Smart Choices Info Series

•

Sensible Snack Program

•

Nutrition Posters

•

Smart Choices Monthly Theme Day

The cafés are designed to offer something for everyone, from a salad entrée to a full hot meal. New menu items will be introduced throughout the year. Whitsons has also invested in professional signage and merchandising that will create a food court-style environment. It’s like going out to lunch without ever leaving the building. Our goal is to entice your children to make nutritious and delicious meal choices.

Secondary School Food Stations All items comply with HHFA and are designed to appeal to a teen palate • Miss Ruby’s Grill - featuring fresh grab and go grilled options • La Cucina - authentic fresh crust pizza and stuffed breads • Chef Productions - hot entrees made from scratch daily • Great American Sandwich Co. - made-to-order Boar’s Head deli sandwiches and wraps • Frait Express - grab and go sandwiches and salads made fresh daily • Spice Program - monthly themed specialty entrees • Smart Snacks - fresh and prepackaged snacks following nutritional guidelines • Smart Choices - healthy entree selections are highlighted throughout server

About Whitsons Whitsons is a boutique regional company founded in 1979 by Elmer and Gina Whitcomb, and handed down to their seven sons and two daughters. Today, the Whitcomb family remains actively involved in the company’s management and has been joined by an “extended family” of team members who share their vision and commitment to bringing the best in dining services to your schools. In addition to school nutrition, Whitsons’ scope of expertise and services extends to: corporate dining, on-site meal preparation for residential and healthcare clients, delivered meals, emergency dining, and vending services. Your opinion matters to us – if you have any suggestions for the school nutrition program, just call your Food Service Director Mary Mills @ 914-738-8110 Ext 1184. We are here to serve you and your child’s needs, and look forward to being a part of your community for many years.

Date Withdrew__________

Attachment Va

F ____R _____D_____

2016-2017 Application for Free and Reduced Price School Meals/Milk To apply for free and reduced price meals for your children, read the instructions on the back, complete only one form for your household, sign your name and return it to the school office. Call 914-738-9140x1144 if you need help. Additional names may be listed on a separate paper. 1. List all children in your household who attend school:

Student Name

School

Grade/Teacher

Foster Child      

Homeless Migrant, Runaway      

2. SNAP/TANF/FDPIR Benefits: If anyone in your household receives either SNAP, TANF or FDPIR benefits, list their name and CASE # here. Skip to Part 4, and sign the application. Name:______________________________________ CASE #__________________________________ 3. Report all income for ALL Household Members (Skip this step if you answered ‘yes’ to step 2) All Household Members (including yourself and all children that have income). List all Household members not listed in Step 1 (including yourself) even if they do not receive income. For each Household Member listed, if they do receive income, report total income for each source in whole dollars only. If they do not receive income from any other source, write ‘0’. If you enter ‘0’ or leave any fields blank, you are certifying (promising) that there is no income to report. Name of household member

Earnings from work before deductions Amount / How Often Paid

Child Support, Alimony Amount / How Often Paid

Pensions, Retirement Payments Amount / How Often Paid

Other Income, Social Security Amount / How Often Paid

No Income

$ ________ / ________

$ ________ / ________

$ ________ / ________

$ ________ / ________



$ ________ / ________

$ ________ / ________

$ ________ / ________

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

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

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

Total Household Members (Children and Adults) Last Four Digits of Social Security Number: XXX-XX- __ __ __ __

I do not have a SS# 

4. Signature: An adult household member must sign this application and provide the last four digits of their Social Security Number (SS#), or mark the “I do not have a SS# box” before it can be approved. I certify (promise) that all of the information on this application is true and that all income is reported. I understand that the information is being given so the school will get federal funds; the school officials may verify the information and if I purposely give false information, I may be prosecuted under applicable State and federal laws, and my children may lose meal benefits. Signature:__________________________________________________ Date: ___________________ Email Address: ______________________________________________ Home Phone: _________________ Work Phone:_____________________ Home Address:____________________________________________

DO NOT WRITE BELOW THIS LINE – FOR SCHOOL USE ONLY Annual Income Conversion (Only convert when multiple income frequencies are reported on application) Weekly X 52; Every Two Weeks (bi-weekly) X 26; Twice Per Month X 24; Monthly X 12  SNAP/TANF/Foster  Income Household: Total Household Income/How Often: _________________/________________ Household Size: _________________  Free Meals  Reduced Price Meals  Denied/Paid Signature of Reviewing Official________________________________________________________ Date Notice Sent:________________

APPLICATION INSTRUCTIONS To apply for free and reduced price meals, submit a Free Meals/Milk Eligibility Letter received from the Office of Temporary and Disability Assistance OR complete only one application for your household using the instructions.. Sign the application and return the application to the school office. If you have a foster child in your household, you may include them on your application. A separate application is no longer needed. Call the school if you need help: 914738-9140 x1144. Ensure that all information is provided. Failure to do so may result in denial of benefits for your child or unnecessary delay in approving your application. PART 1 ALL HOUSEHOLDS MUST COMPLETE STUDENT INFORMATION. DO NOT FILL OUT MORE THAN ONE APPLICATION FOR YOUR HOUSEHOLD. (1) Print the names of the children, including foster children, for whom you are applying on one application. (2) List their grade and school. (3) Check the box to indicate a foster child living in your household, or if you believe any child meets the description for homeless, migrant, runaway (a school staff will confirm this eligibility). PART 2 HOUSEHOLDS GETTING SNAPS, TANF OR FDPIR SHOULD COMPLETE PART 2 AND SIGN PART 4. (1) List a current SNAP, TANF or FDPIR (Food Distribution Program on Indian Reservations) case number of anyone living in your household. The case number is provided on your benefit letter. (2) An adult household member must sign the application in PART 4. SKIP PART 3. Do not list names of household members or income if you list a SNAP case number, TANF or FDPIR number. PART 3 ALL OTHER HOUSEHOLDS MUST COMPLETE THESE PARTS AND ALL OF PART 4. (1) Write the names of everyone in your household, whether or not they get income. Include yourself, the children you are applying for, all other children, your spouse, grandparents, and other related and unrelated people in your household. Use another piece of paper if you need more space. (2) Write the amount of current income each household member receives, before taxes or anything else is taken out, and indicate where it came from, such as earnings, welfare, pensions and other income. If the current income was more or less than usual, write that person’s usual income. Specify how often this income amount is received: weekly, every other week (bi-weekly), 2 x per month, monthly. If no income, check the box. The value of any child care provided or arranged, or any amount received as payment for such child care or reimbursement for costs incurred for such care under the Child Care and Development Block Grant, TANF and At Risk Child Care Programs should not be considered as income for this program. (3) The application must include the last four digits only of the social security number of the adult who signs PART 4 if Part 3 is completed. If the adult does not have a social security number, check the box. If you listed a SNAP, TANF or FDPIR number, a social security number is not needed. OTHER BENEFITS: Your child may be eligible for benefits such as Medicaid or Children’s Health Insurance Program (CHIP). In order to determine if your child is eligible, program officials need information from your free and reduced price meal application. Your written consent is required before any information may be released. Please refer to the attached parent Disclosure Letter and Consent Statement for information about other benefits. PRIVACY ACT STATEMENT Privacy Act Statement: This explains how we will use the information you give us. The Richard B. Russell National School Lunch Act requires the information on this application. You do not have to give the information, but if you do not, we cannot approve your child for free or reduced price meals. You must include the last four digits of the social security number of the adult household member who signs the application. The last four digits of the social security number are not required when you apply on behalf of a foster child or you list a SNAP, Temporary Assistance for Needy Families (TANF) Program or Food Distribution Program on Indian Reservations (FDPIR) case number or other FDPIR identifier for your child or when you indicate that the adult household member signing the application does not have a social security number. We will use your information to determine if your child is eligible for free or reduced price meals, and for administration and enforcement of the lunch and breakfast programs. We MAY share your eligibility information with education, health, and nutrition programs to help them evaluate, fund, or determine benefits for their programs, auditors for program reviews, and law enforcement officials to help them look into violations of program rules. DISCRIMINATION COMPLAINTS

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 6329992. Submit your completed form or letter to USDA by: (1)

(2)

mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; fax: (202) 690-7442; or

(3) email: [email protected] .This institution is an equal opportunity provider.

Date Withdrew__________

Attachment Vb

F ____R _____D_____

2016-2017 Solicitud de Familia para las Comidas Escolares y Leche Gratis o Precios Reducidos Para solicitar por comidas gratuitas o precios reducidos para sus niños, lea las instrucciones en el reverse, complete este formulario para su hogar, firme su nombre y volver a oficina de la escuela. Llame si usted necesita ayuda 914-738-9140x1144. Nombres adicionales se pueden ser listados en un documento separado. 1. Lista todos los niños en su hogar que asisten una escuela: Nombre del estudiante

Escuela

Grado/Profesor(a)

Hijo/a de crianza

Sin Ingreso, Emigrante, Fugitivo

     

     

2. SNAP/TANF/FDPIR beneficios: Si alguien en su hogar recibe cupones de alimentos, o beneficios de TANF o FDPIR, liste su nombre y CASO # aquí. Vaya a la parte 4, y firme la solicitud. Nombre: ______________________________________ CASO #__________________________________ 3. Informe todos los ingresos para TODOS los miembros del hogar (Omita este paso si usted respondió 'sí' al paso 2) Todos los miembros del hogar (incluyendo a ti mismo y todos los niños que tienen ingresos). Lista todos los miembros de la Familia no aparece en el paso 1 (incluido usted mismo) incluso si no reciben ingresos. Por cada miembro de su familia, si no reciben ingresos, informe los ingresos totales de cada fuente en su conjunto sólo dólares. Si no reciben cualquier otra fuente de ingresos, escriba ' 0 '. Si introduce ' 0' o dejar los campos en blanco, está certificando (prometedor) que no hay informe de ingresos. Nombre del miembro del hogar

Ganancias del trabajo antes de las deducciones Cantidad/Frecuencia

La manutención de menores, pensión alimenticia Cantidad/Frecuencia

Pensiones, los pagos de jubilación Cantidad/Frecuencia

Otros ingresos, Seguridad Social Cantidad/Frecuencia

Sin Ingreso, Emigrante, Fugitivo

$ ________ / _______

$ ________ / _______

$ ________ / _______

$ ________ / ________



$ ________ /________

$ ________ / _______

$ ________ / _______

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

$ ________ /________

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

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

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

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 No tengo

Totales miembros de la familia (niños y adultos) Últimos cuatros dígitos del Numero de Seguridad Social: XXX-XX- __ __ __ __

un SS# 

4. Firma: Un miembro adulto del hogar debe firma esta solicitud y presenta los últimos cuatros dígitos de su Numero de Seguro Social (SS#), o marcar el bloque “No tengo un Numero de Seguro Social) antes de que pueda ser aprobado. Yo certifico (prometo) que toda la información en esta solicitud es verdadero y he reportado todos los ingresos. Yo entiendo que la información se está dando para que la escuela recibirá fondos federales. Los funcionarios escolares pueden verificar la información y si deliberadamente proveo información falsa, puedo ser procesado bajo de leyes estatales y federales, y mis hijos podrían pedir beneficios de comidas.

Firma: __________________________________________________ Fecha: ___________________ Dirección de correo electrónico: _________________________ Teléfono de la casa: _________________Teléfono del trabajo: ____________ Dirección de la casa:_____________________________________

NO ESCRIBA DEBAJO ESTA LINEA- PARA USO DE LA ESCUELA Annual Income Conversion (Only convert when multiple income frequencies are reported on application) Weekly X 52; Every Two Weeks (bi-weekly) X 26; Twice Per Month X 24; Monthly X 12  SNAP/TANF/Foster  Income Household: Total Household Income/How Often: _________________/________________ Household Size: _________________  Free Meals  Reduced Price Meals  Denied/Paid Signature of Reviewing Official________________________________________________________ Date Notice Sent:________________

INSTRUCCIONES DE SOLICITUD Para solicitar comidas gratuitas o precio reducido, presente una carta de Habilitacion recibieron de la Oficina de Temporal y Asistencia de Discapacidad o llene sólo una solicitud de su hogar siguiendo las instrucciones. Firme la solicitud y envíela a oficina de la escuela. Si tiene un hijo de crianza en su hogar, usted puede incluir en su solicitud. Llame a la escuela si necesita ayuda: 914-738-9140x1144. Asegure de que toda la información se proporciona. Si no lo hace puede resultar en la denegación de beneficios para su hijo o retrasos innecesarios en la aprobación de su solicitud. PARTE 1

TODOS LOS HOGARES NECESITEN COMPLETAR LA Información. NO LLENE MAS DE UNA SOLICITUD PARA SU HOGAR. (1) Imprima los nombres de los niños para usted está aplicando en una sola aplicación. (2) Liste su grado y escuela. (3) Marque el bloque para indicar un hijo de crianza que vive en su hogar, o si usted cree y niño cumple con la descripción para personas sin hogar, migrante, runaway (personal de la escuela confirmará esta elegibilidad).

PARTE 2

HOGARES CON CUPONES DE ALIMENTOS, TANF O FDPIR DEBE COMPLETE PARTE 2 Y FIRME PARTE 4 (1) Liste un presente SNAP, TANF, o FDPIR (Programa de Distribución de Alimentos en Reservaciones Indígenas) caso número de alguien viviendo en su hogar. El número del caso esta proporcionado en su tarjeta de beneficios. (2) Un miembro adulto del hogar necesite firmar la solicitud en PARTE 4. Omita PARTE 3. No liste nombres de miembros del hogar o ingresos si lista un caso número de SNAP, TANF o FDPIR número.

PARTE 3

TODOS OTROS HOGARES NECESITEN LLENAR ESAS PARTES Y TODOS DE PARTE 4. (3) Escriba los nombres de todos en su hogar, sean o no recibe ingresos. Incluya su nombre y los niños que usted está solicitando, todos los otros niños, su marido(a), abuelos, e otras personas en su hogar (familia o no). Utilice otra hoja de papel si necesita más espacio. (4) Escriba la cantidad de ingresos Corrientes de cada miembro del hogar recibe, antes de impuestos o otras deducciones, e indique de donde vino, tales como sueldo, asistencia social, pensiones e otros ingresos. Si el ingreso corriente es más o menos del normal, indique el ingreso normal de esa persona. Especifique la frecuencia con la cantidad de ingreso que se recibe: semanal, cada dos semanas, dos veces cada mes, o mensual. El valor de cuidado de niños, proporcionado u arreglado, o cualquier cantidad recibida como pago por cuidado de niños o reembolso de los gastos incurridos por ese cuidado bajo de Cuidado de Niños y Subvención de Desarrollo Bloque, TANF y Programas de Cuidado de Niños de Riesgos no deben ser considerados como ingresos para este programa. (5) La solicitud debe incluir sólo los últimos cuatros dígitos del Numero de Seguridad Social del adulto que firme PARTE 4 si Parte 3 está llenando. Si el adulto no tenga un Numeró de Seguridad Social, marque el casilla. Si usted listó un número de SNAP, TANF o FDPIR, un número de Seguridad Social no es necesario.

OTROS BENEFICIOS: Su hijo(a) puede ser elegible por beneficios como Medicaid o Programa de Seguro Médico para Niños (PSMN). Para determinar si su hijo(a) es elegible, funcionarios del programa necesitan información desde la solicitud de comidas gratis o precio reducido. Su consentimiento escrito se requiere antes de que cualquier información pueda ser puesta en libertad. Por favor, refiérase a la Carta de Revelación Paternal y Declaración de Consentimiento para obtener información sobre otros beneficios. Declaración de Privacidad El Acta de Privacidad: Esto explica como usaremos la información que nos da. El Richard B. Russell Ley Nacional de Almuerzo Escolar exige la información en esta solicitud. Usted no necesita dar la información, pero si no lo hace, nosotros no podemos aprobar su hijo(a) por comidas gratis o a precios reducidos. Debe incluir los últimos cuatro dígitos del número de Seguridad Social del miembro adulto del hogar quien firma la solicitud. Los últimos cuatro dígitos del número de Seguridad Social no son necesarios si usted está solicitando para un hijo de crianza o usted lista un numero de Cupones de Alimentos, Temporal Asistencia para Familias Necesitadas (TANF) o el Programa de Distribución de Alimentos en Reservaciones Indígenas (PDARI) u otro identificador PDARI para su niño o cuando usted indica que el miembro adulto del hogar que firma la solicitud no tiene número de Seguridad Social. Nosotros usaremos su información para determinar si su niño es elegible para recibir comidas gratis o a precio reducido, y para la administración y la ejecución de los programas de almuerzo y desayuno. Es posible que compartiremos su información de elegibilidad con programas de educación, salud, y nutrición para ayudarles a evaluar, financiar, o determinar beneficios para sus programas, auditores para revisar programas, y funcionarios del orden para ayudarles a investigar violaciones de las reglas del programa. Quejas de Discriminación De conformidad con la Ley Federal de Derechos Civiles y los reglamentos y politicas de derechos civiles del Departamento de Agricultura de los EE. UU. (USDA, por sus siglas en ingles), se prohibe que el USDA, sus agencias, oficinas, empleados e instituciones que participan o administran programas del USDA discriminen sobre la base de raza, color, nacionalidad, sexo, discapacidad, edad, o en represalia o venganza por actividades previas de derechos civiles en algn programa o actividad realizados o financiados por el USDA.

Las personas con discapacidades que necesiten medios alternativos para la comunicacion de la informacion del programa (por ejemplo, sistema Braille, letras grandes, cintas de audio, lenguaje de seas americano, etc.), deben ponerse en contacto con la agencia (estatal o local) en la que solicitaron los beneficios. Las personas sordas, con dificultades de audicion o discapacidades del habla pueden comunicarse con el USDA por medio del Federal Relay Service [Servicio Federal de Retransmision] al (800) 877-8339. Ademas, la informacion del programa se puede proporcionar en otros idiomas. Para presentar una denuncia de discriminacion, complete el Formulario de Denuncia de Discriminacion del Programa del USDA, (AD-3027) que está disponible en linea en: http://www.ocio.usda.gov/sites/default/files/docs/2012/Spanish_Form_508_Compliant_6_8_12_0.pdf. y en cualquier oficina del USDA, o bien escriba una carta dirigida al USDA e incluya en la carta toda la informacion solicitada en el formulario. Para solicitar una copia del formulario de denuncia, llame al (866) 632-9992. Haga llegar su formulario lleno o carta al USDA por: (1)

correo: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410;

(2)

fax: (202) 690-7442; o

(3)

correo electronico: [email protected].

Esta institucion es un proveedor que ofrece igualdad de oportunidades.

PELHAM PUBLIC SCHOOLS 575 COLONIAL AVE., PELHAM, NY 10803 • 914-738-9140 • FAX 914-738-2384 Children need healthy meals to learn. Pelham Public Schools offer healthy meals every school day. At the secondary schools, breakfast costs $2.50 and lunch costs $3.25. At the elementary schools breakfast costs $1.50 and lunch costs $2.75. Your children may qualify for free meals or for reduced price meals. Reduced price is $0.25 for breakfast and $0.25 for lunch. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

14.

15. 16. 17.

DO I NEED TO FILL OUT AN APPLICATION FOR EACH CHILD? No. Complete the application to apply for free or reduced price meals. Use one Free and Reduced Price School Meals Application for all students in your household. We cannot approve an application that is not complete, so be sure to fill out all required information. Return the completed application to the school office. WHO CAN GET FREE MEALS? All children in households receiving benefits from SNAP, the Food Distribution Program on Indian Reservations or TANF, can get free meals regardless of your income. Also, your children can get free meals if your household’s gross income is within the free limits on the Federal Income Eligibility Guidelines. Can foster children get free meals? Yes, foster children that are under the legal responsibility of a foster care agency or court, are eligible for free meals. Any foster child in the household is eligible for free meals regardless of income. CAN HOMELESS, RUNAWAY, AND MIGRANT CHILDREN GET FREE MEALS? Yes, children who meet the definition of homeless, runaway, or migrant qualify for free meals. If you haven’t been told your children will get free meals, please call 914-738-9140 or e-mail [email protected] to see if they qualify. WHO CAN GET REDUCED PRICE MEALS? Your children can get low cost meals if your household income is within the reduced price limits on the Federal Eligibility Income Chart, shown on this application. SHOULD I FILL OUT AN APPLICATION IF I RECEIVED A LETTER THIS SCHOOL YEAR SAYING MY CHILDREN ARE APPROVED FOR FREE MEALS? Please read the letter you got carefully and follow the instructions. Call the school at 914-738-9140 if you have questions. MY CHILD’S APPLICATION WAS APPROVED LAST YEAR. DO I NEED TO FILL OUT ANOTHER ONE? Yes. Your child’s application is only good for that school year and for the first 30 operating days of this school year. You must send in a new application unless the school told you that your child is eligible for the new school year. I GET WIC. CAN MY CHILD(REN) GET FREE MEALS? Children in households participating in WIC may be eligible for free or reduced price meals. Please fill out a FREE/REDUCED PRICE MEAL application. WILL THE INFORMATION I GIVE BE CHECKED? Yes and we may also ask you to send written proof. IF I DON’T QUALIFY NOW, MAY I APPLY LATER? Yes, you may apply at any time during the school year. For example, children with a parent or guardian who becomes unemployed may become eligible for free and reduced price meals if the household income drops below the income limit. WHAT IF I DISAGREE WITH THE SCHOOL’S DECISION ABOUT MY APPLICATION? You should talk to school officials. You also may ask for a hearing by calling or writing to: Jackie Vigil, Treasurer, 575 Colonial Ave., Pelham, NY 10803, 914-738-9140. MAY I APPLY IF SOMEONE IN MY HOUSEHOLD IS NOT A U.S. CITIZEN? Yes. You or your child(ren) do not have to be U.S. citizens to qualify for free or reduced price meals. WHO SHOULD I INCLUDE AS MEMBERS OF MY HOUSEHOLD? You must include all people living in your household, related or not (such as grandparents, other relatives, or friends) who share income and expenses. You must include yourself and all children living with you. If you live with other people who are economically independent (for example, people who you do not support, who do not share income with you or your children, and who pay a pro-rated share of expenses), do not include them. WHAT IF MY INCOME IS NOT ALWAYS THE SAME? List the amount that you normally receive. For example, if you normally make $1000 each month, but you missed some work last month and only made $900, put down that you made $1000 per month. If you normally get overtime, include it, but do not include it if you only work overtime sometimes. If you have lost a job or had your hours or wages reduced, use your current income. WE ARE IN THE MILITARY. DO WE INCLUDE OUR HOUSING ALLOWANCE AS INCOME? If you get an off-base housing allowance, it must be included as income. However, if your housing is part of the Military Housing Privatization Initiative, do not include your housing allowance as income. MY SPOUSE IS DEPLOYED TO A COMBAT ZONE. IS HER COMBAT PAY COUNTED AS INCOME? No, if the combat pay is received in addition to her basic pay because of her deployment and it wasn’t received before she was deployed, combat pay is not counted as income. Contact your school for more information. MY FAMILY NEEDS MORE HELP. ARE THERE OTHER PROGRAMS WE MIGHT APPLY FOR? To find out how to apply for SNAP or other assistance benefits, contact your local assistance office or call 1-800-342-3009.

How to Apply: To get free or reduced price meals for your children you may submit an Eligibility Letter for Free Meals received from the NYS Education Department, OR carefully complete one application for your household and return it to the designated office. If you now receive SNAP, Temporary Assistance to Needy Families (TANF) for any children, or participate in the Food Distribution Program on Indian Reservations (FDPIR), the application must include the children's names, the household SNAP, TANF or FDPIR case number and the signature of an adult household member. All children should be listed on the same application. If you do not list a SNAP, TANF or FDPIR case number for all the children for whom you are applying, the application must include the names of everyone in the household, the amount of income each household member, and how often it is received and where it comes from. It must include the signature of an adult household member and the last four digits of that adult's social security number, or check the box if the adult does not have a social security number. An application that is not complete cannot be approved. Contact your local Department of Social Services for your SNAP or TANF case number or complete the income portion of the application.

REDUCED PRICE ELIGIBILITY INCOME CHART Total Family Size 1 2 3 4 5 6 7 8 *Each Add’l person add

Annual

Monthly

Twice per Month

Every Two Weeks

Weekly

$ 21,978 $ 29,637 $ 37,296 $ 44,955 $ 52,614 $ 60,273 $ 67,951 $ 75,647 $ 7,696

$ 1,832 $ 2,470 $ 3,108 $ 3,747 $ 4,385 $ 5,023 $ 5,663 $ 6,304 $ 642

$ 916 $ 1,235 $ 1,554 $ 1,874 $ 2,193 $ 2,512 $ 2,832 $ 3,152 $ 321

$ 846 $ 1,140 $ 1,435 $ 1,730 $ 2,024 $ 2,319 $ 2,614 $ 2,910 $ 296

$ 423 $ 570 $ 718 $ 865 $ 1,012 $ 1,160 $ 1,307 $ 1,455 $ 148

Reporting Changes: The benefits that you are approved for at the time of application are effective for the entire school year. You no longer need to report changes for an increase in income or decrease in household size, or if you no longer receive SNAP. Income Exclusions: The value of any child care provided or arranged, or any amount received as payment for such child care or reimbursement for costs incurred for such care under the Child Care Development (Block Grant) Fund should not be considered as income for this program. Reapplication: You may apply for benefits any time during the school year. Also, if you are not eligible now, but during the school year become unemployed, have a decrease in household income, or an increase in family size you may request and complete an application at that time. The disclosure of eligibility information not specifically authorized by the NSLA requires a written consent statement from the parent/guardian. We will let you know when your application is approved or denied. Nondiscrimination Statement: This explains what to do if you believe you have been treated unfairly. In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: [email protected]. This institution is an equal opportunity provider. Meal Service to Children With Disabilities: Federal regulations require schools and institutions to serve meals at no extra charge to children with a disability which may restrict their diet. A student with a disability is defined in 7CFR Part 15b.3 of Federal regulations, as one who has a physical or mental impairment which substantially limits one or more major life activities. Major life activities are defined to include functions such as caring for one’s self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working. You must request the special meals from the school and provide the school with medical certification from a medical doctor. If you believe your child needs substitutions because of a disability, please get in touch with us for further information, as there is specific information that the medical certification must contain. Confidentiality: The United States Department of Agriculture has approved the release of students names and eligibility status, without parent/guardian consent, to persons directly connected with the administration or enforcement of federal education programs such as Title I and the National Assessment of Educational Progress (NAEP), which are United States Department of Education programs used to determine areas such as the allocation of funds to schools, to evaluate socioeconomic status of the school's attendance area, and to assess educational progress. Information may also be released to State health or State education programs administered by the State agency or local education agency, provided the State or local education agency administers the program, and federal State or local nutrition programs similar to the National School Lunch Program. Additionally, all information contained in the free and reduced price application may be released to persons directly connected with the administration or enforcement of programs authorized under the National School Lunch Act (NSLA) or Child Nutrition Act (CNA); including the National School Lunch and School Breakfast Programs, the Special Milk Program, the Child and Adult Care Food Program, Summer Food Service Program and the Special Supplemental Nutrition Program for Women Infants and Children (WIC); the Comptroller General of the United States for audit purposes, and federal, State or local law enforcement officials investigating alleged violation of the programs under the NSLA or CNA. Sincerely, Angelo Rubbo Assistant Superintendent for Business

PELHAM PUBLIC SCHOOLS 575 COLONIAL AVE., PELHAM, NY 10803 • 914-738-9140 • FAX 914-738-2384

FREE AND REDUCED PRICE MEAL APPLICATION FACT SHEET When filling out the application form, please pay careful attention to these helpful hints. SNAP/TANF/FDPIR case number: This must be the complete case number supplied to you by the agency including all numbers and letters, for example, E123456, or whatever combination is used in your county. Refer to a letter you received from your local Department of Social Services for your case number or contact them for your number. All children with the same case number may be listed on the same application. If anyone in your household receives SNAP, all children living in your household are eligible to receive free meals at school. Direct Certification: If you receive SNAP or TANF, send in the Eligibility Letter from the NYS Education Department instead of completing the application. Make a copy for your records. Foster Child: A child who is living with a family but who is under the legal care of the welfare agency or court may be listed on your family application. List the child's “personal use” income. This includes only those funds provided by the agency which are identified for the personal use of the child, such as personal spending allowances, money received by his/her family, or from a job. Funds provided for housing, food and care, medical, and therapeutic needs are not considered income to the foster child. Write “0” if the child has no personal use income. Household: A group of related or non-related people who are living in one house and share income and expenses. Adult Family Members: All related and non-related people who are 21 years of age and older living in your house. Financially Independent: A person is financially independent and a separate economic unit/household when his or her earnings and expenses are not shared by the family/household. See Reverse for information about Gross Income

Gross Income: Is money earned or received by each member of your household before deductions. Examples of deductions are federal tax, State tax, and Social Security deductions. Examples of gross income are:               

Wages, salaries, tips, commissions, or income from self-employment Net farm income – gross sales minus expenses only – not losses Pensions, annuities, or other retirement income including Social Security retirement benefits Unemployment compensation Welfare payments (does not include value of SNAP) Public Assistance payments Adoption assistance Strike benefits Supplemental Security Income (SSI) or Social Security Survivor's Benefits Alimony or child support payments Disability benefits, including workman's compensation Veteran's subsistence benefits Interest or dividend income Cash withdrawn from savings, investments, trusts, and other resources which would be available to pay for a child's meals Other cash income If you have more than one job, you must list the income from all jobs. If you receive income from more than one source (wage, alimony, child support, etc.), you must list the income from all sources. Current Income: Your income at the present time before deductions. Only farmers, self-employed workers, migrant workers, and other seasonal employees may use their income for the past 12 months reported from their 1040 Tax Forms. Income Exclusions: The value of any child care provided or arranged, or any amount received as payment for such child care or reimbursement for costs incurred for such care under the Child Care Development (Block Grant) Fund should not be considered as income for this program. If you have any questions or need help in filling out the application form, please contact: Name: Amy Heese, Business Office Telephone Number: 914-738-9140 x1144 Email: [email protected]

PELHAM PUBLIC SCHOOLS 575 COLONIAL AVE., PELHAM, NY 10803 • 914-738-9140 • FAX 914-738-2384 Los niños necesitan comidas sanas para aprender. Pelham Public Schools ofrece comidas sanas todos los días escolares. El desayuno cuesta $2.50 y el almuerzo cuesta $3.25 en las escuelas secundarias. En las escuelas primarias, el desayuno cuesta y $1.50 y el almuerzo cuesta $2.75. Sus hijos pueden calificar para recibir comidas gratis o a precios reducidos. El precio reducido es $0.25 para desayuno y $0.25 para almuerzo. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

14.

15. 16. 17.

¿Necesito rellenar una solicitud por cada niño? No. Complete la solicitud para solicitar por comida gratis o a precio reducido. Use una Solicitud de Comidas Escolares Gratis o a Precios Reducidos por todos los estudiantes en su hogar. No aprobemos una solicitud incompleto, así asegúrese llenar toda la información requerida. Entregue la solicitud completa a oficina de la escuela. ¿Quién puede recibir comidas gratis? Todos los niños en hogares que reciben beneficios de SNAP de Estado, el Programa de Distribución de Alimentos en Reservaciones Indígenas o TANF de Estado, pueden recibir comidas gratis a pesar de sus ingresos. También, sus hijos pueden recibir comidas gratis si los ingresos totales de su hogar están dentro de los límites de la Tabla Federal de Elegibilidad de Ingresos. ¿Hijos de crianza pueden recibir comidas gratis? Sí, hijos de crianza que están bajo la responsabilidad legal de una agencia de cuidado de crianza o tribunal, son elegibles para recibir comidas gratis. Cualquier hijo de crianza en el hogar es elegible para recibir comidas gratis sin importar sus ingresos. ¿Pueden niños sin hogar, migrantes, o fugitivos reciben comidas gratis? Si, los niños que cumplen la definición de sin hogar, migrante, o fugitivo califican para recibir comidas gratis. Si nadie se le ha dicho que sus hijos recibirán comidas gratis, por favor llame o envíe un correo electrónico a 914-738-9140 o [email protected] para ver si califican. ¿Quién puede recibir comidas a precios reducidos? Sus hijos pueden recibir comidas a precios reducidos si los ingresos de su hogar están dentro de los límites de precio reducido en la Tabla Federal de Elegibilidad de Ingresos, mostrada en esta solicitud. ¿Debo rellenar una solicitud si he recibido una carta escolar este año que dice que mis hijos están aprobados para recibir comidas gratis? Por favor, lea la carta que recibió con cuidado y siga las instrucciones. Llame la escuela a 914-738-9140 si tenga preguntas. La solicitud de mi hijo(a) fue aprobado el año pasado. ¿Necesito completar otra? Sí. La solicitud de su hijo(a) solo es aceptable para ese año escolar y para los primeros días de este año escolar. Usted necesita enviar una solicitud nueva a menos que la escuela le dijo que su hijo(a) es elegible por el año escolar nuevo. Yo recibo WIC. ¿Mis hijos pueden recibir comidas gratis? Niños en hogares participando en WIC pueden ser elegible para recibir comidas gratis o a precios reducidos. Por favor, llene una solicitud. ¿La información que doy se controla? Sí, y también podemos pedirle que envíe prueba escrita. Si no califico ahora, ¿puedo solicitar más tarde? Sí, puede solicitar a cualquier tiempo durante el año escolar. Por ejemplo, niños con un padre o tutor que se haga sin empleo pueden ser elegibles para recibir comidas gratis o a precios reducidos si los ingresos del hogar caigan bajo el límite de ingresos ¿Qué pasa si no estoy de acuerdo con la decisión de la escuela sobre mi solicitud? Debe hablar con funcionarios de la escuela. Además, puede pedirla por una vista por llamando o escribiendo a: Jackie Vigil, Treasurer, 575 Colonial Ave., Pelham, NY 10803, 914-738-9140. ¿Puedo solicitar si alguien en mi hogar no es un ciudadano de los Estados Unidos? Sí. Usted o sus hijos no necesitan ser ciudadanos de los EE.UU. para calificar para recibir comidas gratis o a precios reducidos. ¿Quién debo incluir como miembros de mi hogar? Tiene que incluir todas las personas que viven en su hogar, familia o no (como abuelos, otros parientes, o amigos) que comparten ingresos y gastos. Es necesario que incluye sí mismo y todos los niños que viven con usted. Si vive con otras personas que son independientes económicamente (por ejemplo, personas que no se apoya, que no comparten ingresos con usted o sus hijos, y que pagan una cuota prorrateada), no las incluya. ¿Qué pasa si mi ingreso no es siempre igual? Apunte la cantidad que recibe normalmente. Por ejemplo, si normalmente gana $1000 cada mes, pero faltó trabajo el mes pasado y ganó $900, indique que gana $1000 cada mes. Si normalmente recibe horas extras, las incluye, pero no incluye si sólo trabaja horas extras a veces. Si usted ha perdido un trabajo o tuvo una reducción en sus horas o ganancias, utilice sus ingresos actuales. Estamos en el ejército. ¿Debemos incluir nuestro subsidio de vivienda como ingreso? Si recibe un subsidio de vivienda fuera de la base militar, debe incluirlo como un ingreso. Sin embargo, si su vivienda es parte de la Iniciativa de Privatización de Viviendas para Militares usted no dede incluir el subsidio para vivienda como ingreso. Mi esposo/a es desplegado en una zona de combate. ¿Es su ingreso considera como ingresos? No, si la paga por combate que se recibe en adición a su salario básico a causa de su despliegue y que no fue recibida antes de ser desplegado, la paga por combate no se considera como ingreso. Comunique con su escuela para más información. Mi familia necesita más ayuda. ¿Hay otros programas que podamos solicitar? Para saber cómo solicitar SNAP de Estado u otros beneficios de asistencia, comunique con su oficina de asistencia local o llame al 1-800-342-3009.

Como solicitar: Para recibir comidas gratis o a precios reducidos para sus hijos, usted puede presentar una carta de Certificación Directa del Estado de Nueva York Oficina de Asistencia Temporal y Discapacidad, o cuidadosamente rellene una solicitud para su hogar y la entregue a la oficina designada. Si usted ahora reciba cupones de alimentos, Asistencia Temporal para Familias Necesitadas (TANF) para los hijos, o participe en el Programa de Distribución de Alimentos en Reservaciones Indígenas (FDPIR), la solicitud tiene que incluir los nombres de los niños, los cupones de alimentos del hogar, número de caso para TANF o FDPIR y la firma de un miembro adulto del hogar. Todos los niños deben estar apuntados en la misma solicitud. Si no apunta un numero de cupón de alimento, TANF o FDPIR para todos los niños para que usted está solicitando, la solicitud debe incluir los nombres de todos en el hogar, la cantidad de ingresos cada miembro del hogar, y la frecuencia con que se recibe y de donde viene. Debe incluir la firma de un miembro adulto del hogar y el número de Seguridad Social de ese adulto, o la palabra “ninguna” si el adulto no tenga un numero de Seguridad Social. Una solicitud incompleta no puede ser aprobada. Comunique con su oficina local del Departamento de Servicios Sociales para cupones de alimentos o el número de TANF o completar la porción de los ingresos de la solicitud.

Precio reducido de elegibilidad tabla de ingresos

Tamaño total de la familia

Anual

Mensualmente

Dos veces al mes

Cada dos semanas

Semanalmente

1 2 3 4 5 6 7 8 * Cada persona adicional Agregar

$ 21,978 $ 29,637 $ 37,296 $ 44,955 $ 52,614 $ 60,273 $ 67,951 $ 75,647

$ 1,832 $ 2,470 $ 3,108 $ 3,747 $ 4,385 $ 5,023 $ 5,663 $ 6,304

$ 916 $ 1,235 $ 1,554 $ 1,874 $ 2,193 $ 2,512 $ 2,832 $ 3,152

$ 846 $ 1,140 $ 1,435 $ 1,730 $ 2,024 $ 2,319 $ 2,614 $ 2,910

$ 423 $ 570 $ 718 $ 865 $ 1,012 $ 1,160 $ 1,307 $ 1,455

$ 7,696

$ 642

$ 321

$ 296

$ 148

Cambios de Información: Los beneficios que usted está aprobado en el momento de la solicitud son efectivos para todo el año escolar. No es necesario informar de estos cambios en un aumento de los ingresos o una disminución en el tamaño del hogar, o si ya no recibe cupones de alimentos. Exclusiones de Ingresos: El valor de cuidado de niños, proporcionado u arreglado, o cualquier cantidad recibida como pago por cuidado de niños o reembolso de los gastos incurridos por ese cuidado bajo de Cuidado de Niños y Subvención de Desarrollo Bloque, TANF y Programas de Cuidado de Niños de Riesgos no deben ser considerados como ingresos para este programa . Declaración de no-discriminación: De conformidad con la Ley Federal de Derechos Civiles y los reglamentos y politicas de derechos civiles del Departamento de Agricultura de los EE. UU. (USDA, por sus siglas en ingles), se prohibe que el USDA, sus agencias, oficinas, empleados e instituciones que participan o administran programas del USDA discriminen sobre la base de raza, color, nacionalidad, sexo, discapacidad, edad, o en represalia o venganza por actividades previas de derechos civiles en algn programa o actividad realizados o financiados por el USDA. Las personas con discapacidades que necesiten medios alternativos para la comunicacion de la informacion del programa (por ejemplo, sistema Braille, letras grandes, cintas de audio, lenguaje de seas americano, etc.), deben ponerse en contacto con la agencia (estatal o local) en la que solicitaron los beneficios. Las personas sordas, con dificultades de audicion o discapacidades del habla pueden comunicarse con el USDA por medio del Federal Relay Service [Servicio Federal de Retransmision] al (800) 877-8339. Ademas, la informacion del programa se puede proporcionar en otros idiomas. Para presentar una denuncia de discriminacion, complete el Formulario de Denuncia de Discriminacion del Programa del USDA, (AD-3027) que esta disponible en linea en: http://www.ocio.usda.gov/sites/default/files/docs/2012/Spanish_Form_508_Compliant_6_8_12_0.pdf. y en cualquier oficina del USDA, o bien escriba una carta dirigida al USDA e incluya en la carta toda la informacion solicitada en el formulario. Para solicitar una copia del formulario de denuncia, llame al (866) 632-9992. Haga llegar su formulario lleno o carta al USDA por: (1) correo: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; o (3) correo electronico: [email protected]. Esta institucion es un proveedor que ofrece igualdad de oportunidad Servicio de Comidas para Niños con Discapacidades: Las regulaciones federales requieren que las escuelas e instituciones sirven comidas sin cargar extra a los niños con una discapacidad que puede restringir su dieta. Un estudiante con una discapacidad se define en 7CFR Parte 15b.3 de regulaciones federales, como uno que tiene un impedimento físico o mental que limita sustancialmente una o más actividades importantes de la vida. Las principales actividades de la vida se definen para incluir funciones como el cuidado, de las tareas manuales, caminar, ver, oír, hablar, respirar, aprender, y trabajar. Usted debe solicitar las comidas especiales de la escuela y proveer la escuela con la certificación médica de un doctor en medicina. Si usted cree que su niño necesita substituciones debido a su discapacidad, por favor ponerse en contacto con nosotros para obtener más información, ya que existe información específica que la certificación médica debe contener. Confidencialidad: Los Estados Unidos Departamento de Agricultura (USDA) ha aprobado la entrega de nombres de estudiantes y el estado de elegibilidad sin consentimiento del padre o tutor, a personas directamente relacionadas con la administración o la ejecución de los programas federales de educación tales como el Título I ya la Evaluación Nacional del Progreso Educativo (NAEP), que son los Estados Unidos programas del Departamento de Educación utiliza para determinar las áreas como la asignación de fondos a las escuelas, para evaluar la situación socioeconómica de la zona de asistencia de la escuela, y para evaluar el progreso educativo. La información también puede ser puesta en libertad a la salud del Estado o los programas locales de alimentación similar al Programa Nacional de Almuerzos Escolares. Además, toda la información contenida en la solicitud gratis o a precios reducidos puede ser entregada a personas directamente relacionadas con la administración o la ejecución de los programas autorizados por la Ley Nacional de Almuerzo Escolar o Ley de Nutrición Infantil, incluyendo el Programa de Almuerzo Escolar Nacional y Programa de Desayuno Escolar, el Programa Especial de Leche, los Niños y Adultos Programa de Alimentos, Programa de Servicio de Alimentos de Verano y el Programa Especial de Nutrición Suplementaria para Mujeres, Infantes, y Niños (WIC), la Contraloría General de los Estados Unidos para fines de auditoria, y funcionarios del orden federal, del Estado, o local investigar la presunta violación de los programas de NSLA o CNA. La divulgación de la información de elegibilidad que no esté específicamente autorizada por el NSLA requiere una declaración de consentimiento escrito por el padre o tutor. Le dejaremos saber cuándo su solicitud sea aprobada o negada. Sinceramente, Angelo Rubbo Assistant Superintendent for Business

PELHAM PUBLIC SCHOOLS

ESSENTIAL EMERGENCY CONTACT INFORMATION SCHOOL: ________________________________ 1. Review and, if necessary, correct our contact info for you for 2016-2017 in the right-hand column.

CURRENT INFORMATION

CORRECTIONS/ADDITIONS

STUDENT _____________________________________________ Name

STUDENT ___________________________________________ Last Name, First Name

_____________________________________________ Grade Date of Birth FIRST PARENT/GUARDIAN

___________________________________________ Grade Date of Birth FIRST PARENT/GUARDIAN

_____________________________________________ Name

___________________________________________ Last Name, First Name

_____________________________________________ Address

___________________________________________ Address

____________ *Home Phone

_____________ *Home Phone

______________ *Cell Phone

_______________ *Work Phone

_____________ *Cell Phone

_____________ *Work Phone

_____________________________________________ E-Mail SECOND PARENT/GUARDIAN

___________________________________________ E-Mail SECOND PARENT/GUARDIAN

_____________________________________________ Name

___________________________________________ Last Name, First Name

_____________________________________________ Address

___________________________________________ Address (Complete only if address is different from first parent/guardian.)

____________ _____________ *Home Phone *Cell Phone

_____________ *Home Phone

________________ *Work Phone

_____________________________________________ E-Mail

_____________ *Cell Phone

_____________ *Work Phone

___________________________________________ E-Mail

* THESE NUMBERS WILL BE CALLED IN AN EMERGENCY BY OUR TELEPHONE BLAST SYSTEM.

2. List LOCAL persons, INCLUDING CAREGIVER, to call when parent is UNAVAILABLE in an emergency. (Please complete in order of preference for contact during an emergency.)

Name

Relationship

Primary Phone #

Secondary Phone #

Caregiver

3. Do you want to receive phone texts in school emergencies:

 Yes

 No

(If you wish to receive texts in emergencies, depending on your carrier and phone plan, you may incur a charge.)

4. Check if we can share your e-mail address with:  Your PTA 5. Please list primary language spoken at home:

 Pelham Education Foundation

______________________________________________

______________________________________________ Parent/Guardian Signature

Lockouts… lockdowns… snow storms… an injured child… We need to be able to contact you in an emergency.

THE FIRST STEP IS THAT WE HAVE YOUR CORRECT CONTACT INFORMATION. PLEASE ANSWER ALL FIVE QUESTIONS ON THIS FORM AND RETURN TO YOUR CHILD’S SCHOOL OFFICE BY THE FIRST DAY OF SCHOOL. Note: Be sure to add us to your address book. For example, if your child is in Colonial School, add [email protected] and pelhamschools.org. Check your junk mail/spam mail.

Your cooperation is greatly appreciated.

(Please see other side.)