Florida Agricultural and Mechanical University Developmental Research School

Home of the Baby Rattlers

where we believe in
EXCELLENCE WITHOUT EXCUSE!

Reading for Success

The whole world opened to me when I learned to read.
~Mary Mcleod Bethune

2015 2016
School Year

Ms. Raquista Claitt, Instructor

E-Mail Address: famudrs@hotmail.com
FAMUDRS.Weebly.com
Telephone: 850.412.5930

IGNED

FORMS PACKET

I have read and discussed all of the materials contained in the syllabus and Signed Forms packet
with my parent/legal guardian.
STUDENT NAME ____________________________________________________ (PRINTED)
STUDENT SIGNATURE _______________________________________ DATE_________________
I have read and discussed all of the materials contained in the syllabus and Signed Forms packet
with my child.
PARENT/LEGAL GUARDIAN NAME __________________________________________ (PRINTED)
PARENT/LEGAL GUARDIAN SIGNATURE ______________________________ DATE___________

Signed Forms &

Contracts

TABLE OF CONTENTS

Developmental Research School

Expectations Contract
Student Demographic Form
Grade Assignment Log
Schoology Guidelines and Schoology Code of Conduct
Photo Release Form
Basic Procedures Form
Uniform Policy Contract
Emergency & Medical Information Disclosure Form
Computer, iPad, and Technology Rules Acknowledgement Form
Volunteer Application/Form
Pen Pal/Student Cultural Exchange Permission Form
Google Docs & Gmail Account Permission Form
Video/Film Viewing Permission Slip
Parental Comment/Suggestion Form (optional)
*Special Note: It is vital that all forms and contracts are reviewed before they are assigned. It is also
critical that all forms are returned to the instructor with the appropriate signatures in the designated time
frame. Please sign the front cover of the packet as well as complete the forms contained inside with the
requested information.

Thank you!

EXPECTATIONS CONTRACT
I, _________________________________________________, have read the course syllabus, the
classroom guidelines/behavioral expectations, and supporting documents for my Career and
Technical Education Course on this _______ day of _____________________ 20______.

I UNDERSTAND THAT
I am responsible for fulfilling my responsibilities as a Reading Education student.
I am responsible for my actions and the choices I make.
I am responsible for my own learning, and therefore, I must dedicate my efforts to my
success at all times.

My positive and best efforts will result in success.

New ideas and methods stimulate critical thinking and therefore,
them.

I should be more receptive to

I attend school and this class on a regular basis, I will be a more successful learner.
If I attend school and this class on a regular basis, I will be a more responsible, reliable, and
If

competitive student.
All of the standards of FAMU DRS apply to
Education department.

me as well as those which are unique to the Reading

Failure to maintain a standard of continual improvement will jeopardize

the Reading Education class(es) in which

Student Name (Printed)

I am enrolled.

my grade and success in

______________________________________________________
Student Signature
Date

Parental/Guardian Agreement
I have reviewed this document with my child and agree to do whatever is necessary to ensure that my child succeeds in
his/her Reading Education course(es).

Parent/Guardian Name (Printed)

______________________________________________________
Parent/Guardian Signature
Date

Instructor Agreement
I will provide a knowledgeable, encouraging, and caring environment in order to ensure student learning.

Ms. Raquista Claitt

Instructor Name (Printed)

______________________________________________________

Student Demographic Form

Student Last Name

Student First Name

Student Alias/Nickname

First Name

Relationship

Grade Level

TELEPHONE/CONTACT NUMBERS

Parent/Guardian #1
Last Name
Home Telephone Number

Cell Phone Number

Work Number

E-mail Address

Alternate E-mail Address

I prefer to be contacted by
E-mail
Home Telephone #

Alternate Telephone Number

Cellphone #

Parent/Guardian #2

Parent/guardian contacted to confirm telephone numbers

Last Name

First Name

Relationship

Home Telephone Number

Cell Phone Number

Work Number

E-mail Address

Alternate E-mail Address

I prefer to be contacted by
E-mail
Home Telephone #

Alternate Emergency Contact

Work Telephone #

Secondary/Emergency Contact?

Alternate Telephone Number

Cellphone #

Work Telephone #

This person will be contacted if the primary and secondary emergency contacts are unreachable.

Last Name

First Name

Relationship

Home Telephone Number

Cell Phone Number

Work Number

E-mail Address

Alternate E-mail Address

I prefer to be contacted by
E-mail
Home Telephone #

Secondary/Emergency Contact?

Alternate Telephone Number

ADDRESS/MAILING INFORMATION
Street Address
Living Address

City, State, Zip Code

Street Address

City, State, Zip Code

Mailing Address

Primary/Emergency Contact?

Cellphone #

Work Telephone #

(if different from living)

PHYSICAL DESCRIPTION OF THE STUDENT
Gender
Approximate Height

Male

Hair Color/Description

Eye Color/Description

Approximate Skin and General Physical Description

Female
Created by: Ms. Raquista Claitt, 2009; Revised, 08/2015

The information contained on this form is true and accurate to the best of my knowledge. _________________________________________________(Parent Signature) __________ (Date)

Developmental Research School

Raquista Claitt, Reading Instructor & CTE Instructor

Student Name:

Quarter

Semester

Year

Course Title:

Grade/Assignment Log
Assignment Description

Date
Assigned

Date
Due

Grade

Grade Total
Weight Points

Comments

*Maintenance of the Grade/Assignment Log is the sole responsibility of the student. Logs will be check periodically.

Parent Signature:

Student Signature:

Schoology Guidelines
www.schoology.com

Posting Messages
Post a note to the whole group if your question is about something the whole group should know (assignments,
instructions, dates etc.)
Send a note only to your teacher if you want to talk about something that doesnt relate to everyone.
Dont post personal questions to the group.
Keep conversations on topic.
If youre not sure if a word or joke is okay, then its probably not. Refrain from posts that tease, bully, annoy,
spam, or gossip about any other member.
Replying to Messages
Do not answer a question if you arent sure you know the answer.
Do not reply to a question if someone has already answered it correctly.
Groups
If you think there is something inappropriate posted in a Schoology group, tell a teacher immediately.
Punctuation & Grammar
No txting lingo. We r ur teachersshow us that u have learned how 2 spell.
DO NOT PUT SENTENCES IN ALL CAPITAL LETTERS.
Do not end sentences with more than one exclamation mark!!!!!!!!!!!!!! Or question mark????????????
Please please please do not repeat a word more than necessary.

Schoology Code of Conduct

1.

I will use one of the avatars included with Schoology for my profile picture or use one that is appropriate and
that I have appropriate legal permission to use (i.e. in the public domain).

2.

I will use posts to discuss school-related content only.

3.

I will use a respectful tone of voice when posting. All school rules and consequences related to harassment
apply.

4.

I will use appropriate grammar instead of texting language.

5.

I will not use my posts to promote personal websites or chat rooms.

6.

I will limit my use of sarcasm to avoid misinterpretations.

7.

I will not reveal any personal information on Schoology. This includes telephone numbers, addresses, emails,
etc.

8.

I will not post photos or videos showing myself or classmates without permission.

I understand and agree to follow the Schoology Guidelines and Code of Conduct indicated above as well as any
additional guidelines discussed during class.

Students Printed Name: _________________________________________________________________

Student Signature: _________________________________________ Date: ______________________
I have discussed these Schoology Guidelines and Code of Conduct with my child.

Parents Printed Name: __________________________________________________________________

Parent Signature: _________________________________________ Date: _______________________

Photo Release Form

Developmental Research School

This form confirms the agreement between you and FAMU DRS regarding your childs participation in FAMU DRS activities in
which your child may be photographed or videotaped (the Property) from time to time. For valuable consideration received, you
hereby irrevocably grant to FAMU DRS perpetually, exclusively, and for all media throughout the world (including print, nontheatrical, home video, CD-ROM, internet and any other electronic medium presently in existence or invented in the future), the
right to use and incorporate (alone or together with other materials), in whole or in part, photographs or video footage taken of
your child as a result of your childs participation in FAMU DRS courses and activities. You hereby agree that you will not bring
or consent to others bringing claim or action against FAMU DRS on the grounds that anything contained in the Property, or in
the advertising and publicity used in connection herewith, is defamatory, reflects adversely on you or your child, violates any other
right whatsoever, including, without limitation, rights of privacy and publicity. You hereby release FAMU DRS, its directors,
officers, successors, faculty, staff, affiliations, and assigns from and against any and all claims, demands, actions, causes of actions,
suits, costs, expenses, liabilities, and damages whatsoever that you may hereafter have against FAMU DRS in connection with the
Property. This agreement shall not obligate FAMU DRS to use the Property or to use any of the rights granted hereunder, or to
prepare, produce, exhibit, distribute or exploit the Property. FAMU DRS shall have the right to assign its rights hereunder,
without your consent, in whole or in part, to any person, firm or corporation.
That is, I hereby grant to FAMU DRS and its representatives, employees, agents and assigns, the irrevocable and unrestricted
right to use, reproduce and publish photographs of me, including my image and likeness as depicted therein and including my
name as depicted therein; to alter the same without restriction; and to copyright the same. I hereby release FAMU DRS and its
trustees, officers, employees, agents, legal representatives and assigns from any and all claims, actions and liability relating to its
use of said photographs and name.
In addition, I hereby irrevocably authorize the FAMU DRS to edit, alter, copy, exhibit, publish or distribute this photo for
purposes of publicizing the FAMU DRS programs or for any other lawful purpose. In addition, I waive the right to inspect or
approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to
royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever
discharge FAMU DRS from all claims, demands, and causes of action which I, my heirs, representatives, executors,
administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this
authorization.
I am the parent and/or legal guardian of the indicated child/student and am competent to contract in my own name and his/her
name. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.

AUTHORIZATION/CERTIFICATION OF RELEASE
I hereby certify that I am the parent and/or legal guardian of ________________________(child/student),
and do hereby give my consent for my child/student to be photographed or videotaped during school
activities and functions.
Parent/guardian name (print) ______________________________ Signature ______________________________
Child/student name (print) _______________________________ Signature ______________________________

AGREED TO AND ACCEPTED this ____________day of __________________________, 20_____

Parent/Guardian Address________________________________ City ________________ State ____ Zip ______
Parent/Guardian E-Mail Address_________________________________________________________________
P/G Cellphone Number ___________________ P/G Work or Home Telephone Number ___________________

Developmental Research School

BASIC
PROCEDURES

Lectures/Discussions/Activities
After completing our warm up activities (if applicable), Ms. Claitt will engage
students in the days activities. During this time, there will be NO inappropriate
talking, sleeping, or disruptions tolerated during this time. This will be your
opportunity to obtain valuable knowledge and skills and should be taken seriously.
During this time, please remember the following:
1. Students will NOT be given permission to leave the room for any reason (other than fire drills and extreme emergencies).

Ms. Claitt values each and every minute she is with her students because it is a time of learning and growth; any disruptions
which prohibit my students from learning and growing will not be tolerated. Therefore, please do not ask for permission to
leave the room; this includes, but is not limited to, permission to go to the bathroom (students may have their personal boxes
of Kleenex and hand sanitizer for illness and will therefore not have to go to the bathroom for that), permission to go to
another teachers classroom, or permission to go to lockers.

2. Cell phones are NOT permitted in this classroom AT ANY TIME. Should students have cell phones
they must be TURNED OFF (not simply placed on vibrate or any other alternative) and they must be
kept out of sight. Parents please do not call your child on a cell phone during the school day; should you
need to contact a student please call the main office. Cell phones are extremely disruptive to a classroom
setting and will not be tolerated. Should a cell phone ring during class the student will surrender the cell
phone to Ms. Claitt (who will then give it to the principal), will receive a referral, and may earn
repercussions.

3. During announcements (PA system and other), stop all activities and sit quietly to listen. There is no talking or any other
activities done at this time even if the announcement does not pertain to you.
4. Should we have guests to visit our classroom or should we visit another classroom or leave our classroom for any reason,

students will behave with decorum befitting a serious, professional student. Students will behave professionally and
appropriately and will exude pride and confidence. Please remember that a guest is anyone other than the students
enrolled in the class who enters our classroom.

5. Backpacks are not permitted in the classroom. Per the administrative policy, student backpacks must be kept in their
lockers. During class, students will NOT be allowed to return to lockers or backpacks. (The locker rental fee is $10/year.)

6. Students will behave appropriately and intelligently at all times. Students will follow directions explicitly and efficiently.
Students will understand that they are here to receive an education reflect that understanding in through their behavior,
actions, and ability to complete assigned tasks.

Dismissal
Please remember the bell does not dismiss you. Ms. Claitt will attempt to provide students with 35 minutes to clean their
areas and prepare for the next class. Students will not be allowed to leave the classroom until their area is clean, their computers
are shut down, and their chairs are pushed in. Students will quietly remain in their seats and await dismissal until Ms. Claitt
dismisses them.
Students are not permitted to leave the classroom until the following:
Ms. Claitt says, You are dismissed or Ms. Claitt says a variation of this statement.

Parents

Please remember that I value every minute with my students. Please do not call students on cell phones. Should you
need to speak to a student during class or leave something for him/her, please contact the principal or main office.
Parent/Guardian Name (print) _____________________________ Signature _____________________________
Child/Student Name (print) _______________________________ Signature _____________________________
AGREED TO AND ACCEPTED this ____________day of __________________________, 20______

Developmental Research School

UNIFORM POLICY CONTRACT

I, _________________________________ (PARENT/LEGAL

GUARDIAN

), have read and understand the

uniform policy for FAMU DRS (refer to the Student Code of Conduct)
___________________________________(STUDENT), and we (

PARENT/LEGAL GUARDIAN

&

STUDENT

with my child,

) agree to abide by and

adhere to the policies, procedures, and consequences associated with the FAMU DRS Uniform Policy.
We understand that our appearance sends forth a message and my childs appearance will send forth a
message of pride, confidence, professionalism, and respect. Everyday my child will enter the classroom
ready, willing, and prepared to learn dressed in proper attire according to the Florida Agricultural and
Mechanical University Developmental Research School Student Code of Conduct (including, but not
limited to: clean, neat clothing, appropriate colors for each clothing item and footwear, tucked shirts,
clothing with the appropriate fit, et cetera).

_______________________________
Students Printed Name

_______________________________
Parents/Guardians Printed Name

_______________________________
Students Signature

_______________________________
Parents/Guardians Signature

_______________________________
Date

_______________________________
Date

Summary of Uniform Policy found in Student Handbook/Student Code of Conduct for the 2015 2016 School Year
Boys are to wear navy trousers/pants (or shorts) with a whit Oxford (button down) or white polo shirt (or a solid white shirt with a collar and
buttons), with no additional insignias or markings other than the official FAMU DRS/University logo. Shirts must be tucked into the
trousers/pants.(or shorts). A BLACK BELT must be worn with the uniform pants with a buckle that should not exceed the width of the
waistband. Cargo pants/trousers are NOT permitted. Trousers/pants are to be worn snugly and securely around the waist (sagging is NOT
permitted).
Girls are to wear plaid (navy blue and kelly green), navy pants/trousers, jumpers, shorts, or skorts with a white Oxford (button down) or a
white polo shirt (or a solid white shirt with a color and buttons), with no additional insignias or markings other than the official FAMU
DRS/University logo. Shirts must be tucked into the trousers/pants, shorts, skirts, or skorts. Shorts and skirts (and all bottoms) must be worn
at an appropriate length, with a minimum five-inch inseam on shorts, skirts, skorts or jumpers and which must extend to or past the
students fingertips. A BLACK BELT must be worn with uniform skirts, skorts, pants/trousers, jumpers, or shorts with a buckle that should
not exceed the width of the waistband. Appropriate undergarments must be worn at all times.
Footwear should be SOLID BLACK in color and cover the entire foot. Sneakers, tennis shoes, and common dress shoes are appropriate as
long as they are solid black. (Canvas sneakers, slides, thongs, flip-flops, and heels above two inches are prohibited.)
Special Note: Nothing in this Summary is meant to usurp or supersede any information or policies covered in the FAMU DRS Student Handbook/Student Code of Conduct. The FAMU DRS Student Handbook/Student Code of
Conduct is the ultimate and final authority/policy on student attire.

Developmental Research School

Emergency & Medical

Information Disclosure Form

It is imperative to me that I remain in contact with my students parents so that we may work together as a
team to ensure each childs success and well-being. Please provide any pertinent medical information
regarding your childs health (i.e., allergies, phobias, et cetera), physicians information, and sequence of
contacting persons in case of emergency. Thank you.
Student Name: ____________________________________________________ Student Grade Level: _____
Pertinent Medical Information: _________________________________________________________________
__________________________________________________________________________________________
Has the FAMU DRS administration been made aware of this condition/information? _______________________
Pertinent Medical Information: _________________________________________________________________
__________________________________________________________________________________________
Has the FAMU DRS administration been made aware of this condition/information? _______________________
Medications Currently or Previously Taken by Student: _______________________________________________
__________________________________________________________________________________________
Has the FAMU DRS administration been made aware of this medication and provisions made? ________________
Parent/Guardian Affirmation
To the best of my knowledge, the information provided is correct, complete, and up-to-date.
Parent/Guardian Printed Name: ________________________________________________________________
Parent/Guardian Signature: ____________________________________________________________________
1. Parent/Guardian Contact Number(s): __________________________________________________________
2. Parent/Guardian Alternate Contact Information: _________________________________________________
Parent/Guardian E-Mail Address: _______________________________________________________________
4. Emergency Contact Name: __________________________ Emergency Contact Number(s): ______________
5. Emergency Contact Name: __________________________ Emergency Contact Number(s): ______________
If unable to reach a parent/guardian, please follow the sequence above in reaching contact persons.

PARENT/LEGAL GUARDIAN SIGNATURE _______________________________ RELATIONSHIP TO STUDENT ____________

PARENT/LEGAL GUARDIAN PRINTED NAME ____________________________________ DATE ____________________

Computer, iPad, and

Technology Rules
TECHNOLOGY IS A POWERFUL LEARNING TOOL; HOWEVER, IT MUST NOT BE ABUSED AND IT
MUST NOT BE USED INAPPROPRIATELY. ALL CAREER AND TECHNICAL EDUCATION STUDENTS
MUST ADHERE TO THE FOLLOWING RULES REGARDING TECHNOLOGY IN THE CLASSROOM.

All students must have a completed FAMU DRS Student Internet User Application submitted and on file.
All students must have a completed Schoology Guidelines and Schoology Code of Conduct submitted and on
file.
All students must have a completed Anti-Cyber Bullying Pledge submitted and on file.
Downloading any unauthorized software, games, and/or other interactive media is PROHIBITED (a
violation of this rule will earn a student appropriate repercussions)
All computers, Kindles, iPads, and other form of technology must be handled responsibly, with care, and are
not to be misused, abused, vandalized, altered, or stolen.
Unless otherwise noted due to a planned integration in a class activity or unless otherwise given express,
explicit permission from Ms. Claitt, students may not log onto any personal networking or communication
websites (including, but not limited to: Facebook, Instagram, Twitter, Tumblr, Kik, My Space, G-Mail,
Hotmail, Yahoo Mail, et cetera).
Unless otherwise noted due to a planned integration in a class activity or unless otherwise given express,
explicit permission from Ms. Claitt, student may NOT log onto or play any video games, music websites, or
other entertainment sites.
There will be certain activities for which personal cell phones may be utilized during class. This does NOT
mean that cell phones are permissible for student use during class time at any other time. Additionally, this
does NOT mean students are required to have cell phones. It is to simply say that there may be certain
activities that may allow for personal cell phone usage should students have and choose to use them.
(Advance notice will be provided.) *Please note, current school policy does not allow students to have cell
phones in the classroom without express, explicit permission from their teacher.
No eating or drinking near or around any form of technology in the classroom or lab.
Unless otherwise noted due to integration in the class activity or unless otherwise given express, explicit
permission from Ms. Claitt, students may not utilize personal technology (i.e., iPods, iPads, e-Readers, MP3
players, cell phones, cameras, et cetera). Special permission may be given by Ms. Claitt depending upon the
circumstance and activity.
Students must NOT utilize computers, Kindles, iPads, or any other form of technology to participate in cyber
bullying or cyber harassment in any form while enrolled in a FAMU DRS Reading Education course. Should
any student becomes aware of, is a witness to, or is a victim of cyber bullying or cyber harassment, he or she
must promptly report the offense to a teacher or administrator.
Parent/guardian name (print) ______________________________ Signature ______________________________
Child/student name (print) _______________________________ Signature ______________________________
AGREED TO AND ACCEPTED this ____________day of _________________, 20_____
(Day)

(Month)

(Year)

PARENT COMMENTS
& SUGGESTIONS
It is imperative to me that I remain in contact with my students parents so that we may work together as a
team to ensure each childs success. I am always appreciative of new ideas and welcome your opinions,
creative criticisms, comments, and suggestions. Though I admit that I maintain high academic and
behavioral standards for students, I do so only because I firmly believe in the potential and abilities of each
and every child at FAMU Developmental Research School. Please use the following area to share any
questions, comments, or concerns. Thank you for entrusting me with your childs educational growth.

__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
______________________________
PARENT/LEGAL GUARDIAN SIGNATURE

______________________________
DATE