Mechanicsburg Exempted Village School District
Forms
Table of Contents


5000 - STUDENTS
5111f1Parent-Grandparent Consent Form
5111f2aResidency Affidavit
5111f2bResidency Verification
5111f3Inability to Provide Certified Birth Certificate
5111f4Superintendent's Agreement to Enroll a Nonresident Student
5111f5Verification of Employment
5111f6Verification of Medical Condition
5111f7Power of Attorney
5111f8Caretaker Authorization Affidavit
5111f9Checklist of Items to Request and/or Verify in Connection with Power of Attorney or Caretaker Authorization Affidavit
5112f1Referral Form for Possible Academic Acceleration
5113f1Notification of Acceptance (Adjacent-District Student)
5113f2Notification of Non-Acceptance (Adjacent-District Student)
5113f3Parent Agreement to an Inter-District Open-Enrollment
5113.01f1Notification of Acceptance (Nonhome-School Student)
5113.01f2Notification of Non-Acceptance (Intra-District)
5113.01f3Parent Agreement to Nonhome-School Enrollment
5113.02f1Sample Supplemental Educational Service Provider Agreement
5130f1Elementary School Check-Out Procedure
5130f2Middle School Check-Out Report
5130f3High School Student Check-Out
5230f1Early Release Form
5320f1Confirmation of MMR Booster Vaccination
5330f1Authorization for Prescribed Medication/Drug or Treatment
5330f1aAuthorization for Nonprescribed Medication or Treatment (Secondary Version)
5330f1bAuthorization for Nonprescribed Medication or Treatment (Elementary Version)
5330f2Medication Administration Daily Log
5330f3Authorization for the Possession and Use of Asthma Inhaler /Other Emergency Medication(s)
5330f4Authorization for the Possession and Use of Epinephrine Autoinjector (Epi-pen)
5330.01f1Parental Authorization for the Administration of Potassium Iodide
5336f1Written Notification to School Employees Regarding Training to Provide Diabetes Care to Students
5340f1Accident Report
5340f2Shop Accident Report
5341f1Emergency Medical Authorization
5350f1Suicide Report Form
5350f2Assessment of Suicide Risk
5410f1Referral Form for Possible Whole-Grade or Subject Acceleration
5464f1Request for Early Completion of Graduation Requirements
5464f2Referral Form for Possible Early High School Graduation
5500f1Student Handbook Certification
5513f1Textbook Condition
5513f2Breaking & Entering/Vandalism Report
5515f1Application to Drive Vehicles on School Property
5515f2Parental Authorization and Release From Liability Form From Transportation in Student Vehicle Related to School-Sponsored Activity
5517f1Report of Harassment
5530f2Memorandum to Parents Regarding School Board Policy on Drug-Free Schools
5605f1Log of Disciplinary Actions - Student with Disability
5610f1Notification of Emergency Removal
5610f2Notice of Intent to Suspend
5610f3Notice of Suspension
5610f4Notice of Intended Bus Suspension
5610f5Notice of Bus Suspension
5610f6Notice of Intention to Expel
5610f7Notice of Expulsion
5610f8Agreement to Hold Expulsion (Suspension) in Abeyance
5610.02f1In-School Restriction, After-School Detention, or Saturday Detention
5610.05f1Prohibition to Participate in Extra-Curricular Activities
5630f2Report on Administration of Corporal Punishment
5771f1Student Locker Assignment Authorization Form
5771f2Record of Student Search and Seizure
5780f1Acceptance of Rights/Responsibilities
5780f2Student Affidavit in Support of a Claim of Emancipation for School Purposes
5830f1Student Fund-Raising Activity
5830f2Parent Permission for Student Participation in Fund-Raising
5830f3Report of Fund-Raising Activity
5830f4Student Fund-Raising Projects/Student Participation Form
5880f1Student Performance Request/Report