2014-15 Enrollment Night Information Collierville Schools

Town of Collierville Residents Only

March 24, 2014*

4:30 – 7:00 p.m.

Grades 1 & 2

Grade 8

Grades 9-12

March 25, 2014*

4:30 – 7:00 p.m.

Grades 3 & 4

Grade 7

Grades 9-12

March 27, 2014*

4:30 – 7:00 p.m.

K and Grade 5

Grade 6

Grades 9-12 *Incoming 2014-15 grade Bus transportation is not provided for Enrollment Night.

Self-Contained Special Education

Students in self-contained Special Education classes will register on August 4, 2014, the first full day of school,

and do not need to be present on Enrollment Night (March 24, 25 or 27). Parents are encouraged to contact the

school and speak with the Special Education Secretary to confirm enrollment prior to the first day of class.

Items Needed for Enrollment

*Proof of Residence: Parents/guardians must provide TWO of the following items showing the

parent/guardian’s name and address to prove residency:

1. Most recent MLGW or municipal water bill of the owner, renter or lessee of the home in which the student will reside during the current school year;

2. Mortgage statement or deed of the owner of the home in which the student will reside during the current school year; 3. Lease of the lessee of the home in which the student will reside during the current school year; 4. Rental Agreement of the renter of the home in which the student will reside during the current school year; 5. Real Estate tax receipt; 6. Public assistance/government benefits check, card, or papers; 7. In the event that two (2) of the items listed above cannot be provided, residency may be established by submitting other

documentation deemed to be appropriate proof of residence by the department responsible for verifying residency.

Immunization Records

NEW IMMUNIZATION REQUIREMENTS: K-12 students must have a TN School Immunization Certificate

showing:

Two (2) doses of MMR Two (2) doses of Varicella

or proof of Chickenpox Four (4) doses of Polio

Four (4) doses of DTP-

Hib-Td (all students)

Two (2) doses of

Hepatitis A (Grade K); Tdap Booster

(7th

Grade Entry Only) Three (3) doses of Hepatitis

B (Grade K & 7)

For more on state-required immunizations, please refer to the Immunization Requirements at the following state website:

https://health.state.tn.us/ceds/required.htm.

New Student Enrollment

Students who have previously enrolled in another school system in Tennessee may enroll pending receipt of their

academic and health records. Students transferring into the system from an out of state school or from a non-

public school must provide a Tennessee Department of Health Immunization Certificate that includes a physical

exam. The following documents are required:

1. Proof of Residence: Same as above. Proof of residence is required of all students at enrollment and may be

required of any student during the school year.

2. Social Security Number: Bring student’s Social Security Card. (T.C.A. 49-6-5102)

3. Tennessee Department of Health Immunization Certificate: Contact the school for additional information.

4. Kindergarten Students must be 5 years old on or before August 15, 2014, and the following items must

be provided:

A. Certified copy of Birth Certificate

B. Proof of recent medical examination

C. Tennessee Department of Health Immunization Certificate with proof of a physical

exam within 12 months prior to enrollment.

D. Social Security Card

E. If applicable, custody papers and parent plan

Collierville Schools offers educational and employment opportunities without regard to race, color, creed, national origin, religion, sex, age,

or disability and adheres to the provisions of the Family Education Rights and Privacy Act (FERPA).

Frequently Asked Questions About Enrollment Night 2014 Collierville Schools

March 24, 2014*

4:30 – 7:00 p.m.

Grades 1 & 2

Grade 8

Grades 9-12

March 25, 2014*

4:30 – 7:00 p.m.

Grades 3 & 4

Grade 7

Grades 9-12

March 27, 2014*

4:30 – 7:00 p.m.

K and Grade 5

Grade 6

Grades 9-12 *Incoming 2014-15 grade

1. What are the dates and times for the enrollment night? Please see the table above for dates and times for enrollment.

2. What school should I attend to enroll my child? Parents should enroll their child at the school he/she will be attending for the 2014-15 school year (i.e., current 5th

graders report to assigned middle school and current 8th graders report to high school).

3. Who should attend enrollment night? All Town of Collierville students zoned for Collierville Schools for the 2014-15 school year. Students currently attending a

Collierville school and not zoned for Collierville Schools (CS) should not attend. If not zoned for CS for 2014-15, please

complete a non-resident form available on our website.

4. If I attend enrollment night, do I have to attend regular registration on July 29, 2014? Yes. You must attend the regular registration on July 29 to pick up teacher assignments, class schedules and

transportation information; otherwise, all enrollment data will be purged. Proof of residence will not be required on July

29 if previously presented on enrollment night.

5. What will I need to bring with me on enrollment night for students enrolling in grades K –

12? Proof of Residence - At registration, parents/guardians must provide TWO of the following items showing the

parent/guardian’s name and address to prove residency:

1. Most recent MLGW or municipal water bill of the owner, renter or lessee of the home in which the student will reside

during the current school year;

2. Mortgage statement or deed of the owner of the home in which the student will reside during the current school year;

3. Lease of the lessee of the home in which the student will reside during the current school year;

4. Rental Agreement of the renter of the home in which the student will reside during the current school year;

5. Real Estate tax receipt;

6. Public assistance/government benefits check, card, or papers;

7. In the event that two (2) of the items listed above cannot be provided, residency may be established by submitting

other documentation deemed to be appropriate proof of residence by the department responsible for verifying

residency.

SEE ENROLLMENT IMMUNIZATION REQUIREMENTS ON PAGE 2 BELOW.

Immunization Records: K-12 students must have Tennessee School Immunization Certificate showing:

Two (2) doses of MMR Two (2) doses of Varicella

or proof of Chickenpox Four (4) doses of Polio

Four (4) doses of DTP-

Hib-Td (all students)

Two (2) doses of

Hepatitis A (Grade K); Tdap Booster

(7th

grade entry only) Three (3) doses of Hepatitis

B (Grade K & 7)

6. For students to enter kindergarten, the student must be five (5) years of age on or before

August 15. What will I need to bring with me on enrollment night for students enrolling in kindergarten?

Birth Certificate (Certified Copy Only – Not Mother’s Copy) Social Security Card (Actual Card) Physical with Immunization Record (will be accepted on July 29, 2014, also) Parenting Plan and Custody Papers Driver’s License (for identification only)

7. What if I am assigned to a school, but I want to attend another school in Collierville?

Report to the school where you want to attend and complete a student transfer form, as well as other required documents. For example, if you current attend one Collierville elementary school and would like to attend another Collierville elementary school in the Fall attend that school for early registration. You will receive notification later in the Spring regarding acceptance.

8. What is the difference between a non-resident student and a transfer student? Non-resident

students are those who are not zoned to attend Collierville Schools. Transfer students are those students residing in the Collierville Schools district who wish to attend a different school within the Collierville Schools (doesn’t apply to high school).

9. Who around Collierville is considered a non-resident student for Collierville Schools? Anyone residing in the Collierville Reserves or in any other municipality or area outside the boundaries of the Town of Collierville.

10. If I completed a Non-Resident Application for Collierville Schools, do I need to attend enrollment night? No. You will be notified on the status of your non-resident application during April.

11. Who pays tuition? Students who live outside of Shelby County will be required to pay tuition.

12. What about shared residency? Shared residency will be accepted on the enrollment nights of March 24, 25, or 27. If you have shared residency, please report to the school with all required paperwork. .

Collierville Schools offers educational and employment opportunities without regard to race, color, creed, national origin, religion, sex, age or disability and adheres

to the provisions of the Family Rights and Privacy Act (FERPA).

Items Accepted for Proof of Residence

2014-15

Collierville Schools

Please provide two (2) of the following seven (7) items showing the parent/guardian’s name and

address to prove residence:

1. Most recent MLGW or municipal water bill of the owner, renter or lessee of the home in which the student will reside during the current school year;

2. Mortgage statement or deed of the owner of the home in which the student will reside during the current school year;

3. Lease of the lessee of the home in which the student will reside during the current school year; 4. Rental Agreement of the renter of the home in which the student will reside during the current school

year;

5. Real Estate tax receipt; 6. Public assistance/government benefits check, card, or papers; 7. In the event that two (2) of the items listed above cannot be provided, residency may be established by

submitting other documentation deemed to be appropriate proof of residence by the department

responsible for verifying residency.

Any child up to the eighteenth birthday whose parents are bona fide residents of Collierville is entitled to attend

Collierville Schools.

Only the residence of the parent with legal custody may be used for registration. (T.C.A.§49-6-3103) In cases

where parents have joint custody, only the address of the parent named as the primary custodian or designated

primary responsibility to determine educational issues may be used for registration. The parent whose residence

qualifies the child to be registered is the parent the school personnel will consider as the custodial parent. The

noncustodial parent may receive school records when a written request is given to the school principal in

compliance with T.C.A.§49-6-902 or T.C.A.§36–6–104.

Any child who has been legally adopted by persons who are bona fide residents of Collierville is entitled to attend

Collierville Schools (CS Board Policy 6.204).

Wards of the Juvenile Court who have been placed in custody of a bona fide resident of Collierville are entitled to

attend Collierville Schools (CS Board Policy 6.204).

Any child approved under the non-resident policy is entitled to attend Collierville Schools (CS Board Policy

6.204).

Collierville Schools’ policy prohibits the enrollment of any student other than the above described. “Any parent,

guardian, or other legal custodian who enrolls an out-of-district student in a school district and fraudulently represents the address for

the domicile of the student for enrollment purposes is liable for restitution to the school district for an amount equal to the local per

pupil expenditure identified by the Tennessee Department of Education for the district in which the student is fraudulently enrolled.

Any parent, guardian, or other legal custodian who enrolls an out–of-state student in a school district and fraudulently represents the

address for the domicile of the student for enrollment purposes is liable for restitution to the school district for an amount equal to the

state and local per pupil expenditure identified by the Tennessee Department of Education for the district in which the student is

fraudulently enrolled… .”

Collierville Schools offers educational and employment opportunities without regard to race, color, creed, national origin, religion, sex, age, or disability

and adheres to the provisions of the Family Rights and Privacy Act (FERPA).

Student Enrollment Form 2014-15

Collierville Schools

For School Use Only: Birth Cert ________ Physical ________ Immunization Cert ________ SS Card ________

Proof of Residence: ______ Mortgage ______ Lease ______ Rental Agreement ______ Sales Contract ______ Real Estate Tax ______ MLGW/Water Bill

______ Public Assistance Docs ____ Military Housing Letter ____ Other deemed appropriate by school admin (list)__________________

Proof of residence if living with someone else: ______ Notarized Proof of Residence Form Completed ______ Administrative Approval

Teacher __________________________ Date of enrollment ________________ Bus RT# ______________ Daycare ________ Car ________ Walker ________

Has student ever attended another Tennessee Public School? Yes No

Has student ever attended a Shelby County (or Memphis City)

school? Yes No

Last School Attended

School Name Address City State

Student Social Security Number Student’s Legal Last Name First Name Middle Name Birth Date (mm/dd/yyyy) Generation (Jr, II, etc.)

Gender

Male

Female

Federal Ethnic Category:

Hispanic or Latino

Not Hispanic or Latino

Federal Race Category: Mark one or more races to indicate what you consider your child to be. (Even if “Hispanic or Latino” has

been chosen for ethnicity, the child must be recorded as being one or more of the following races.) Grade Level

Asian

White

American Indian or Alaska Native

Native Hawaiian and Other Pacific Islander

Black/African-American

Student’s Physical Address (Address of Parent/Legal Guardian)

Street Number Street Name Apartment City State Zip

Parent/Legal Guardian #1

Title (Mr., Mrs, etc.) Last Name First Name Middle Name Generation

Preferred Language English Spanish Other Translator Needed? Yes No

Home Phone Work Phone Cell Phone Email

Relationship

Student Lives With

Mother

Father

Both

Other

Employed By Federal Employee Yes No

Parent/Legal Guardian or

Other Contact #2

Title (Mr., Mrs, etc.) Last Name First Name Middle Name Generation

Preferred Language English Spanish Other Translator Needed? Yes No

Home Phone Work Phone Cell Phone Email

Relationship

Student

Lives With

Mother

Father

Both

Other

Employed By Federal Employee Yes No

Emergency Contact #1

Title (Mr., Mrs, etc.) Last Name First Name Middle Name Generation

Preferred Language English Spanish Other Translator Needed? Yes No

Home Phone Work Phone Cell Phone Email

Relationship

List siblings attending

Collierville Schools

Name Birth Date Gender Grade School

Are there any Legal Alerts the school needs to be aware of? Yes No If Yes, please explain and provide appropriate documents (for example, court orders).

Has the student ever been enrolled in a Special Education/Resource/504/Gifted Program? Yes No

If yes, what type of program? Where? When?

Student’s Birth Place (City) Birth State Birth Country

If Immigrant, Date Entered U.S. Year Started School First Date Enrolled in U.S. School

(mm/dd/yyyy)

(yyyy)

(mm/dd/yyyy)

Mother’s Maiden Name Birth County Birth City

Is English primary language spoken by student? Yes No Is English language limited? Yes No List Home Language

Collierville Schools offers educational and employment opportunities without regard to race, color, creed, national origin, religion, sex, age, or

disability and adheres to the provisions of the Family Rights and Privacy Act (FERPA).

Primary Home Language Survey 2014-15

Collierville Schools The parent or legal guardian should complete this form during registration. Date _______________ Student Name _________________________ Sex _____ Date of Birth ___________________ School _______________________________ Grade ______Student # __________________ Home Telephone _______________________ Cell Phone________________________ The native/home language of each student must be recorded in his/her permanent record.

Please answer the following questions about your child’s language background: 1. What is the first language this child learned to speak? ________________________________ 2. What language does this child speak most often outside of school? _____________________ 3. What language do people usually speak in the child’s home? __________________________

Listing another language other than English to any of the questions above DOES NOT qualify a student as an English language learner. It does require, however, that the student participate in an approved language proficiency assessment to determine language proficiency and possible ESL classification based on these assessment results. If any question is answered with another language other than English, a copy of this form should be forwarded to the local school ESL teacher for language assessment testing.

Collected for Funding Purposes Only:

Was this child born in the United States? _____Yes _____No If no, what is the country of birth? _____________________________________________ Date entered the United States: ______________________________________ Date entered schools in the United States: ________________________________ Has this student ever been enrolled in an ESL program? _____Yes _____No In what language do you want correspondence sent to you from school? _____________________

Signature of Parent/Guardian

Collierville Schools offers educational and employment opportunities without regard to race, color, creed, national origin, religion, sex, age or

disability and adheres to the provisions of the Family Rights and Privacy Act (FERPA).

Revised 03/2014

Student Name (print)

Date of Birth

Parent/Guardian Name

Address

Phone

Please circle 2014-15 grade level: pre-K K 1 2 3 4 5 6 7 8 9 10 11 12

Waiver of Immunization Requirements State Law (T.C.A. 49-6-5001) provides waiver of immunization requirements under the following conditions:

1. In the absence of epidemic or threat of epidemic, parents may object in writing when immunization conflicts with the teachings and practice of a well recognized religious denomination to which the parents adhere. However, if an epidemic or

threat of epidemic occurs, objections on behalf of religious teaching are invalid.

2. Certificate in writing from a physician stating that such immunization would be harmful to the child involved is provided to the school for the student’s permanent file.

EXEMPTIONS

If your child has not received all the required immunizations, complete the appropriate section and return this form to your child’s

school.

Medical Exemption

The following immunizations are medically contraindicated and constitute a threat to the child’s health. Please check the

appropriate vaccine below:

Dtap HIB Hepatitis B Polio

Varicella (Chickenpox) MMR Hepatitis A S. Pneumo

Physician’s Signature _____________________________________________Date_________________________

Religious Exemption

Parent or guardian of the above named child adheres to a religious belief whose teachings are opposed to such immunizations.

State your reason for requesting a religious exemption:

__________________________________________________________________________________________

__________________________________________________________________________________________

______________________________________________________

Parent/Guardian Signature __________________________________Date________________

Important: Students exempted from immunizations may be excluded from school if one of these vaccine-preventable diseases is identified in the school.

Children excluded from school will be prohibited from attending school until either the child is immunized and the danger of outbreak is past, or the child

contracts the disease and completely recovers.

Collierville Schools offers educational and employment opportunities without regard to race, color, creed, national origin, religion, sex, age, or disability and adheres to the provisions of the Family Rights and Privacy Act (FERPA).

Revised 2/2014

Immunization Exemption Form 2014-15

Collierville Schools

Coordinated School Health

Received date___________

Entered in PowerSchool under

Special Medical Considerations:

By ____________________

Date___________________

Application for Non-Resident Admission 2014-2015

Collierville Schools Please provide the following information and return the completed form by mail to Collierville Schools 500 Poplar View Parkway, Collierville, TN

38017 or drop off at any area Collierville school main office. Forms returned by April 4, 2014 will have top priority. Forms turned in after April 4, 2014

will be handled on a case by case basis.

Legal Parent/Guardian Name __________________________________Phone ____________________

Street Address ___________________________ Email _________________________________

City ____________________County ____________________State _____Zip _____________

Student’s Name ________________________________Grade Entering ___________

School Last Attended _______________________School Last Attended Phone _____________

CS School(s) Requesting to Attend ______________________________________________________

2014-15 School Zoned to Attend___________________________________________________

Non-resident students will be considered for attendance with Collierville Schools based on the following priorities. Documentation is

required for priority selection. Please indicate priority below with an X.

__ Priority 1: Non-resident students who are children of full-time employees of Collierville Schools.

__ Priority 2: Non-resident students currently enrolled in one of the eight (8) Collierville schools.

__ Priority 3: Non-resident students whose siblings are currently enrolled in one of the eight (8) Collierville

schools.

__ Priority 4: Non-resident students who are children of full-time employees of the Town of Collierville.

__ Priority 5: When rezoning anywhere in Shelby County takes place, those non-residents residing in an

area that is closer to a Collierville school they wish to attend than the rezoned school, may have priority.

__ Priority 6: Non-resident students residing within Shelby County.

__ Priority 7: Non-resident students residing outside Shelby County but within the State of Tennessee.

Check if served by: Special Education ________ 504 __________ ESL _________

If Special Education, what services are currently provided (ex. Co-teaching, resource, SLP, OT, etc.)______________________

Has your child been suspended or expelled from school during the last school year? ____ Yes ____ No If Yes, please

explain________________________________________________________________________________________________

Parents/legal guardians must submit the following documents with application for non-resident student admission:

Student’s most recent report card

High School only: copy of transcript (if available) and list of all schools attended since 8th grade.

I have read the District’s Non-Resident Policy 6.204 and understand and agree to the terms. I understand this application does not

mean automatic admission into Collierville Schools.

__________________________________ _______________

Parent/Guardian Signature Date

For Office Use Only Application _____ Granted ______ Denied

Reason Denied _____ Grade _____ Attendance _____ Discipline _____ Space Availability ____ Staffing ____ Priority Level

Official Reviewer Signature:__________________________________________ Date:____________________

Collierville Schools offers educational and employment opportunities without regard to race, color, creed, national origin, religion, sex, age or disability and adheres to the provisions of the Family Rights and Privacy Act (FERPA).

REQUEST FOR STUDENT TRANSFER

Only Open to Residents of the Town of Collierville

PLEASE PRINT:

Student’s Full Name:___________________________________________________ Race:__________ Gender:______________

Address: Street ______________________________________ Apt#________ City _____________________ Zip ___________

Do you live within the boundaries of the Town of Collierville? _____Yes _____No

Phone Numbers: Home ________________________ Work ________________________ Cell ___________________________

Current School Assignment:__________________________________________ Present Grade:__________________________

Desired School Assignment:__________________________________________

Check if served by: Special Education _____________ 504 _____________ ESL _______________

If Special Education, what services are currently provided (ex. Co-teaching, resource, SLP, OT, etc.):_______________________

________________________________________________________________________________________________________

Are there childcare issues that impact this transfer request? ______ Yes______ No. If yes, explain________________________

________________________________________________________________________________________________________

Is your request to transfer related to a substantial hardship or based on safety concerns? ______ Yes______ No. If yes,

explain__________________________________________________________________________________________________

Your transfer request will be approved or denied by Student Services based on Board Policy 6.206. If my request is granted I understand that my

child’s renewal for following years depends on satisfactory attendance, academic effort, and conduct, and I will be responsible for transportation to

the requested school. I certify that all information provided is true and correct and I am the legal parent or guardian of this child.

Parent/Guardian Name (PRINT) ______________________________________________________________________________

Parent/Guardian Signature___________________________________________________________ Date___________________

RETURN THIS FORM, ALONG WITH ALL OTHER REQUIRED FORMS, TO THE SCHOOL YOU WISH YOUR CHILD TO

ATTEND DURING EARLY ENROLLMENT MARCH 24, 25, OR 27TH. YOU WILL BE NOTIFIED OF ACCEPTANCE BY LATE

APRIL.

Office Use Only:

Transfer Request ____________ Approved ____________ Denied

Signature of Official___________________________________________________________________ Date____________________________

Collierville Schools offers educational and employment opportunities without regard to race, color, creed, national origin, religion, sex, age or disability and adheres

to the provisions of the Family Rights and Privacy Act (FERPA).

John S. Aitken

Superintendent of Schools

Mark Hansen Board Chairman

Wanda Chism

Board Member

Kevin Vaughan

Board Member

Cathy Messerly

Board Member

Wright Cox

Board Member

Shared Residency Information Items Needed for Shared Residency Verification

In the event a student resides with his/her parents/guardian in the home of another person:

The homeowner of the home must accompany the parent/guardian and provide two (2) of the items listed below:

Most recent MLGW bill or municipal water bill

Mortgage statement or deed

Lease

Rental Agreement

Real Estate tax receipt

Other documentation deemed appropriate by Student Services

The parent/guardian must provide two (2) of the following items bearing the address at which the student will be residing:

Car Registration

Voter Registration

Payroll Stub

Three (3) significant pieces of mail (equivalent to one (1) proof of residence)

Government Assistance Communication

The parent/guardian must provide the completed Shared Residency Affidavit. (See attached).

John S. Aitken

Superintendent of Schools

Mark Hansen Board Chairman

Wanda Chism

Board Member

Kevin Vaughan

Board Member

Cathy Messerly

Board Member

Wright Cox

Board Member

Shared Residence Affidavit

This form is to be completed if residency requirements cannot be provided due to the fact that the parent and

child(ren) are sharing a home with another person SEVEN days a week year round. This affidavit must be re-

certified annually.

To be completed by Parent(s)/Guardian(s):

Student: Last Name First Name: M F Birthdate: / / Grade:

Student: Last Name First Name: M F Birthdate: / / Grade:

Parent(s) Name:

Last Name: First Name:

Last Name: First Name:

Address: City: State: Zip:

Phone:____________________________ Cell:___________________________ Work:______________________

This living arrangement is: ___ temporary Duration:___________________ or ____ permanent

The address listed above is my only residence. I agree to notify Collierville Schools if there is any change in the status

of my residence. I understand that home visitation and/or residency verification is part of the process when residency

is established by an Affidavit of Shared Residence.

_____________________________________ ___________________________________ ______________

Signature of Parent/Legal Guardian TN Driver’s License/ID Card Number Date

Please complete page two of this form as well.

Collierville Schools offers educational and employment opportunities without regard to race, color, creed, national origin, religion, sex, age or disability and adheres

to the provisions of the Family Rights and Privacy Act (FERPA).

John S. Aitken

Superintendent of Schools

Mark Hansen Board Chairman

Wanda Chism

Board Member

Kevin Vaughan

Board Member

Cathy Messerly

Board Member

Wright Cox

Board Member

Shared Residence Affidavit

To be completed by the homeowner:

I, _________________________________________ (Name of Owner, Lease Holder, Qualified Relative, Friend, Neighbor, etc.)

declare/certify that I am the primary resident/owner at ___________________________________

____________________________________________ (street address, city, state, zip) and that the above mentioned adult(s) and

student(s) reside with me on a full time basis (seven days a week year round). I agree to notify Collierville Schools if there is any

change in the status of residence of the person listed above. I understand home visitation and/or residence verification is part of the

process when residency is established by a Shared Residency Affidavit. I further agree to provide proof of my residence to

Collierville Schools.

_________________________________ _____________________________________ _____________

Signature of Primary Resident/Owner TN Driver’s License/ID Card Number Date

Notary:

State of Tennessee, County of ______________________________________

On _______________________ before me _________________________________________, Personally

appeared ____________________________________________________ (Name(s) of Signer(s))

_______________________________________________________________________________,

Place Notary Seal below Who to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are

subscribed to the within instrument and acknowledged to me that he/she/they executed the same in

his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the

person(s), or the entity upon behalf of which person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of Tennessee that foregoing paragraph is

true and correct. Witness my hand and official seal.

__________________________________________________________

Signature of Notary Public

Collierville Schools offers educational and employment opportunities without regard to race, color, creed, national origin, religion, sex, age or disability and adheres

to the provisions of the Family Rights and Privacy Act (FERPA).

John S. Aitken

Superintendent of Schools

Mark Hansen Board Chairman

Wanda Chism

Board Member

Kevin Vaughan

Board Member

Cathy Messerly

Board Member

Wright Cox

Board Member