Miscellaneous Forms

See below for "Policy-Related Forms" section.

Disciplinary Action Forms (Click here for Student Guidance Documents & Forms)

Evacuation Site License Agreement for Schools

License Agreement Sample Letter

Permit to Leave Elementary School Grounds

Permit to Leave Elementary School Grounds During School Hours

Photograph/Video Recording Consent Forms

          Consent for Use of Photographs (English & Spanish)

          Consent for Release of Images (English & Spanish)

Power of Attorney Forms (Click here for Student Guidance Documents & Forms)

Statements of Awareness for Students  (Click here for Student Guidance Documents & Forms)    

Student Classroom Observation Approval - Form Letter

Letter from Principal to Observer (To be signed before entering classroom)

Taxi Service for Student Transportation Off Campus (Click here for Student Guidance Documents & Forms)

 

Policy-Related Forms

SECTION B:  
BBB-F Board Member Oath of Office
BBFA-F Board Member Conflict of Interest
BDC-F Executive Sessions
BDDH-F Request to Address the Board
BHE See Audit Dept. Intranet site for School Support Organization forms.
   
SECTION D:  
DJH-R-F Corporate Card Cardholder Responsibilities and Agreement
   
SECTION E:  
EBA-R(1)-F Emergency Response and Incident Command Procedures - School Emergency Response Plan  (Click here for fillable form.)
EBA-R(2)-F Drill Report  (Complete and submit this form using the OnBase system to report fire drills, lockdown drills, and off-site evacuations. See Security website for completion instructions.)
EDB-F Equipment Transfer Form (See Property Management Intranet site.)
EGAA-R-F(1) Copyright - Request for Permission to Reprint Copyrighted Material
EGAA-R-F(2) Copyright - Authorization to Reprint Copyrighted Material
EJ-R-F Report/Certificate of Records Destruction
   
SECTION G:  
GBA-R-F Equal Employment Discrimination/Retaliation Complaint Form
GBA-R-F(S) Equal Employment Discrimination/Retaliation Complaint Form - Spanish Version
GBCA-R-F(1) Workplace Conflict of Interest Form (Nepotism)
GBCA-R-F(2) Financial Conflict of Interest Memorandum to Purchasing
GBCB-R-F(1) Annual Statement of Understanding (For All Employees) COPY ON WHITE PAPER ONLY
GBCB-R-F(1)S Annual Statement of Understanding (For All Employees) - Spanish Version - COPY ON WHITE PAPER ONLY
GBCB-R-F(2) Statement of Awareness - Classified Employee COPY ON WHITE PAPER ONLY
GBCB-R-F(2)S Statement of Awareness - Classified Employee - Spanish Version - COPY ON WHITE PAPER ONLY
GBCB-R-F(3) Statement of Awareness Addendum - Classified Employee 
GBCB-R-F(3)S Statement of Awareness Addendum - Classified Employee - Spanish Version 
GBCB-R-F(4) Statement of Awareness - Certificated Employee COPY ON WHITE PAPER ONLY
GBCB-R-F(5) Statement of Awareness Addendum - Certificated Employee 
GBCB-R-F(6) Statement of Awareness - Classified Director COPY ON WHITE PAPER ONLY
GBCB-R-F(7) Statement of Awareness - Classified Supervisor COPY ON WHITE PAPER ONLY
GBCB-R-F(8) Statement of Awareness Addendum - Classified Director or Supervisor 
GBCB-R-F(9) Statement of Awareness - Certificated Administrator COPY ON WHITE PAPER ONLY
GBCB-R-F(10) Statement of Awareness - Specialist COPY ON WHITE PAPER ONLY
GBCB-R-F(11) Statement of Awareness Addendum - Administrator/Specialist
GBCX-R-F Complaint of Workplace Harassment
GBCX-R-F(S) Complaint of Workplace Harassment - Spanish Version
GBKB For Drug & Alcohol Testing Locations and Checklists, see the Human Resources Intranet site.
GBLA-F Authorization to Release Information
GBQB-F Copyright and Invention Assignment Agreement
GCD-R-F Loyalty Oath – Professional Staff
GCPA-R Classroom Teacher/Counselor/Student Advisor RIF Profile - See HR
GCPD-F(1) Employee Letter of Reprimand: Professional Staff
GCPD-F(1) Employee Letter of Reprimand: Professional Staff (Fillable version)
GCPD-F(2) Appeal of Letter of Reprimand: Professional Staff
GDD-R(1)-F(1) Support Staff Hiring – Background Investigation Form (Employer)
GDD-R(1)-F(2) Support Staff Hiring – Background Investigation Form (Personal)
GDD-R(1)-F(3) Support Staff Loyalty Oath
GDD-R(2)-F Support Staff Hiring – Fingerprint Requirements
GDPD-R-F(1) Employee Written Warning: Building/Unit Level 
GDPD-R-F(2) Employee Letter of Reprimand: District Level  
GDPD-R-F(3) Classified Personnel Appeal Form: Letter of Reprimand/Suspension With or Without Pay 
GEA-R-F(1)

Volunteer Application & Referral Forms

GEA-R-F(2) Field Experience Agreement for Volunteer
GEA-R-F(3) Certification of Classified Employee Regarding Volunteer Activity
GEA-R-F(4) Certification of Classified Employee Regarding Volunteer Coaching
GEC-F Field Experience Agreement for Student Practitioner
   
SECTION I:  
IGBF-R (ADE form #1) Primary Home Language Other Than English (PHLOTE) Home Language Survey
IGBF-R (ADE form #2) Parental Waiver Application
IGBF-R (ADE form #3) Parent Request for Student Withdrawal from an English Language Learner Program
IGBF-R (ADE form #4) AZELLA Placement Test - Teacher Referral Form
IGBH-R-F(1) Checklist for Referral of a Special Education Student to a Focus School/Alternative Program (To be updated by Special Education Department staff)
IGBH-R-F(2) Checklist for Special Education Student to Return from a Focus School/Alternative /Program (To be updated by Special Education Department staff)
IGDD-F Criteria for Performances and Presentations to Students
IGDF-R-F Activity/Fund Raising Request
IGDJ-R-F(1) Athletics Statement of Awareness
IGDJ-R-F(2) Athletics Physical Form (Part A)
IGDJ-R-F(2) Athletics Health History Form (Part B)
IIAB-R-F Request for Lost/Damaged Textbook Fine Waiver
IIBE-R-F Video Use Request (For Videos Not Rated G or Equivalent)
IICA-R In-State/Single Day Travel Planning Guide
IICA-R Out-of-State/Overnight Travel Planning Guide
IKE-R(1)-F(1) Letter to Parents re: Promotion/Retention of Kdg Students
  WORD version of letter
IKE-R(1)-F(1)S Letter to Parents re: Promotion/Retention of Kdg Students - Spanish Version
  WORD version of letter
IKE-R(1)-F(2) Letter to Parents re: Promotion/Retention of 1st-6th Gr Students
  WORD version of letter
IKE-R(1)-F(2)S Letter to Parents re: Promotion/Retention of 1st-6th Gr Students - Spanish Version
  WORD version of letter
IKE-R(1)-F(3) Promotion/Retention Form - MPS Record of Student Progress and Grade Placement
IKE-R(1)-F(3) Promotion/Retention Form - MPS Record of Student Progress and Grade  Placement (Fillable version)
IKE-R(1)-F(3)S Promotion/Retention Form - MPS Record of Student Progress and Grade Placement - Spanish Version
IKE-R(2)-F(1) Annual Notification Letter to Parents Regarding 3rd Grade Reading Level
IKE-R(2)-F(1)S Annual Notification Letter to Parents Regarding 3rd Grade Reading Level - Spanish Version
IKE-R(2)-F(2) Letter from Principal to Parents of Student in Need of Extra Reading Instruction and Support
IKE-R(2)-F(2)S Letter from Principal to Parents of Student in Need of Extra Reading Instruction and Support - Spanish Version
IKE-R(2)-F(3) Move on When Reading - Grades K-3 Student Academic Support Plan
IKF-R-F Alternative Graduation Requirements Appeal Form
IKG-R-F(1) Transcripts Evaluation (Fillable)
IKG-R-F(2) Course Challenge Test Application Form (Fillable)
INE-R-F Criteria for Performances and Presentations to Students
ING-R-F(1) Principal Approval Form for Animals in the Classroom
ING-R-F(2) Animals in the Classroom - Parent Notification
ING-R-F(2)S Animals in the Classroom - Parent Notification - Spanish Version
   
SECTION J:  
JB-R(1)-F Section 504 Complaint Form
JB-R(2)-F Complaint of Discrimination
JB-R(2)-F(S) Complaint of Discrimination - Spanish Version
JC-R-F(1) First ­ Request for Proof of Student Identity/Age
JC-R-F(1)S First Request for Proof of Student Identity/Age - Spanish Version
JC-R-F(2) Second Request for Proof of Student Identity/Age
JC-R-F(2)S Second Request for Proof of Student Identity/Age - Spanish Version
JC-R-F(3) Open Enrollment Application  and Open Enrollment Supplement Forms - Spanish Version Available
JC-R-F(4) Principal's Letter to Family Member Enrolling Student Whose Custodial Parent Lives in U.S. - but not AZ (see below for Word version of letter)
JC-R-F(4) Word Version of JC-R-F(4) - Remember to enclose JC-R(15)
JC-R-F(5) Parental Acknowledgement of Responsibility for Part-Time Students
JC-R-F(6) Information for Host Parent Enrolling a Foreign Student Who Requires an I-20
JC-R-F(7) Caregiver & Living Arrangements Affidavit for Homeless or Abandoned Student (McKinney-Vento)
JC-R-F(7)S Caregiver & Living Arrangements Affidavit for Homeless or Abandoned Student (McKinney-Vento) Spanish Version  (If using Chrome, select "print to fit" so that all text is visible.)
JC-R-F(8) Student Identity Affidavit
JC-R-F(8)S Student Identity Affidavit - Spanish Version
JC-R-F(9) Rights of Homeless Students
JC-R-F(9)S Rights of Homeless Students - Spanish Version
JC-R-F(10) Student Referral Questionnaire (McKinney-Vento)
JC-R-F(10)S Student Referral Questionnaire (McKinney-Vento) - Spanish Version (If using Chrome, select "print to fit" so that all text is visible.)
JC-R-F(11) Homeless Student Dispute Resolution Forms
JC (sample) McKinney-Vento - Transportation Agreement
JC (sample) McKinney-Vento - Transportation Agreement - Spanish Version
JC-R-F(12)

Affidavit of Arizona Residency

JC-R-F(12)S Affidavit of Arizona Residency - Spanish Version
JC-R-F(13) Affidavit of Shared Residence
JC-R-F(13)S Affidavit of Shared Residence - Spanish Version
JC-R-F(14) Affidavit of Arizona Residency for Close Relative Living With the Student
JC-R-F(14)S Affidavit of Arizona Residency for Close Relative Living with the Student - Spanish Version
JC-R-F(15) Affidavit of Parent/Guardian Residing Outside of Arizona but in U.S. (used to request "best interest" waiver of tuition)
JC-R-F(16) Letter from Principal Declining Request for Waiver of Tuition
JEAA-R-F(1) Certificate of Chronic Health Condition
JEAA-R-F(1)S Certificate of Chronic Health Condition - Spanish Version
JEAA-R-F(2) Parent Notification of Chronic Health Condition Guidelines
JEAA-R-F(2)S Parent Notification of Chronic Health Condition Guidelines - Spanish Version
JEAA-R-F(3) Chronic Health Condition Eligibility Checklist
JEAA-R-F(4) Parent Notification of Child Placed on Chronic Health Conditions List
JEAA-R-F(4)S Parent Notification of Child Placed on Chronic Health Conditions List - Spanish Version
JEGA For the Affidavit of Intent for Home Schooling, see the website for the Maricopa County School Superintendent.
JEGA-R-F(1) Information Sheet for Parents Instructing their Child(ren) at Home
JEGA-R-F(2) Acknowledgement of Parental Awareness (re: Safety of Children Instructed at Home, But Enrolled Part-Time With District)
JFC-R-F(1) Student Conduct ­ Student Removal from Class
JFC-R-F(2) Notice to Principal of Refusal to Readmit Student
JFCC-R-F(1) School Bus Safety Program - Emergency Bus Evacuation Drill
JFCC-R-F(2) Bus Incident Referral to Administrator (Use Order form 94-80-54 D from MDC.)
JFD-R-F(1) Harassment Report (Fillable form)
JFD-R-F(1) Harassment Report (For completion by hand)
JFD-R-F(1)S Harassment Report - (Spanish Version - Fillable form)
JFD-R-F(1)S Harassment Report - (Spanish Version - For completion by hand)
JFD-R-F(2) Bullying Report (Fillable form)
JFD-R-F(2) Bullying Report (For completion by hand)
JFD-R-F(2)S Bullying Report (Spanish Version - Fillable form)
JFD-R-F(2)S Bullying Report (Spanish Version - For completion by hand)
JFD-R-F(3) Notice of Appeal Rights: Complaint of Discrimination/Harassment Based on Race, Color, National Origin, Religion, Sex, or Disability
JFD-R-F(3)S Notice of Appeal Rights: Complaint of Discrimination/Harassment Based on Race, Color, National Origin, Religion, Sex, or Disability (Spanish Version)
JFD-R-F(4) Notice of Appeal Rights: Bullying Complaint
JFD-R-F(4)S Notice of Appeal Rights: Bullying Complaint (Spanish Version)
JFD-R student pamphlet Student Bullying Notice/Pamphlet (English and Spanish Versions)
JFG-R-F Student Interview or Custody Transfer - For Investigation NOT Related to Child Abuse  [This form is for use by law enforcement officers, probation officers, and representatives from other government agencies. For any investigation related to child abuse, use form JHG-R-F(2).] 
JFH-R-F Freedom of Religious Expression Complaint Form
JGD-F(2) Application for Readmission after Expulsion - Student Report
JGD-F(2)S Appliction for Readmission after Expulsion - Student Report - Spanish Version
JGD-F(3) Application for Readmission - Memo to Governing Board
JGD-F(4) Application for Readmission - Authorization to Release Confidential Information
JGD-F(4)S Application for Readmission - Authorization to Release Confidential Information - Spanish Version
JGD-F(5) Application for Readmission - Conditions of Probation/Conditional Liberty
JGD-F(6) Student Readmission Agreement
JGD-F(6)S Student Readmission Agreement - Spanish Version
JHCD-R-F(1) Consent for School to Administer Medication or Dietary Supplement to Student and Authorization for Release of Health Information (Form 95-76-01 W)
JHCD-R-F(2) Individualized Health Care Plan
JHCD-R-F(3) Consent for Student Self-Administration of Medication or Dietary Supplement at School
JHCD-R-F(4) Medication Incident Report
JHCD-R-F(6) Student Overnight Travel Emergency and Medication Form
JHCD-R-F(6)S Student Overnight Travel Emergency and Medication Form - Spanish Version
JHCD-R-F(7) Release for Student to Carry Prescribed Inhaler or Emergency Medication
JHG-R   OnBase form

Child Abuse Report Form - enter http://Onbase.mpsz.org as URL on Internet Explorer   Form Completion Instructions

JHG-R-F(2) Student Interview or Custody Transfer by Law Enforcement Officer for Child Abuse Investigation  [This form is for use by law enforcement officers investigating child abuse. DCS representatives should use the DCS form for student interviews. For investigations NOT related to child abuse, use form JFG-R-F.]

JHG (DCS form sample #1)

Sample DCS form - Request for Release of Education Records for  child abuse investigation
JHG (DCS form sample #2) Sample DCS form - Request for Release of Education Records for child abuse investigation (if student is ward of Court in legal care, custody and control of DCS)

JHG (DCS form sample #3)

Sample DCS form - Request for Interview at School for child abuse investigation
JHG (DCS form sample #4) Sample DCS form - Notice of Removal
JHG (SRPMIC form sample) Sample of Salt River Pima-Maricopa Indian Community CPS form that an investigator may present to school staff member to interview a student.
JN-F(1) Request for Waiver/Reduction of Student Fee or Material Usage Charge
JN-F(2) Financial Questionnaire for Waiver/Reduction of Student Fee or Material Usage Charge
JO-R-F Parent Authorization for Disclosure or Release of Educational Records
JO (other) Request for Records (by parent, legal guardian, or student over age 18)
   
SECTION K:  
KBA-R-F Request for Public Records of the School District
KBAA-F Request to Withdraw from Activities or Classes
KH-R-F Gift/Donations Acceptance Form (Use MDC form 94-54-01 W .)
KLB-F Citizens Request for Reconsideration of Materials
   
SECTION L:  
LC-F(1) Sample Letter to Researcher to Engage in Research
LC-F(2) Agreement While Conducting Research
LC-F(3) Permission to Engage in Research Form