Strengths and Needs Screener Consent Form

We want to ensure every student in our school receives the support they need to reach their potential. Ongoing screening in both academic and social, emotional, and behavioral functioning can identify students that need additional support to increase their academic performance and improve overall well-being.

Screening tools help school staff develop effective plans and allocate resources at the school, class, and individual levels. This year, we will administer the Strength & Needs Screener.

The results will be used as one data point in a proactive process that supports students with mentoring, organizational strategies, social skills, coping strategies, and other supports that help them fully engage in their learning. If your student is identified as needing additional support, you will be notified just as you would with academic interventions in our building.

With your consent, we can administer the Strength & Needs Screener to your student and determine how we are doing at the school level as well as how to best support your student if additional support is needed.

You may preview the questions on the survey by going to our website at: https://www.siouxcityschools.org/o/sccs/page/youth-needs-screener-survey

Thank you for your continued partnership with your student’s education.

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I wish for my student to participate in the screening assessment this year. By submitting this form, I agree to let my child complete the Strength & Needs Screener survey.

Name of Student *

Name of Parent/Guardian *

Student's School: *

Today's Date: * +

NON-DISCRIMINATION STATEMENT:

The Sioux City Community School District offers career and technical programs in the following areas: Business & Marketing, Family & Consumer Science, Health Science, and Industrial Arts, Technology, & PLTW.

The Sioux City Community School District is an equal opportunity/affirmative action employer and does not discriminate on the basis of race, creed, color, sex, sexual orientation, gender identity, genetic information (for employment), national origin, religion, age (for employment), disability, socioeconomic status (for programs), marital status (for programs), or veteran status (for employment) in its educational programs and its employment practices. The District is required by Title IX and 34 CFR Part 106 not to discriminate on the basis of sex in its programs, activities, or employment.

Inquiries or grievances under Section 504 and Title II of the Americans with Disabilities Act may be directed to Dr. Dora Jung, Director of Student Services/Title IX Coordinator at 627 4th Street, Sioux City, IA 51101, (712) 279-6075, jungd@live.siouxcityschools.com. Inquiries about the application of Title IX and its regulations to the District may be referred to the Title IX Coordinator, the Assistant Secretary of the U.S. Department of Education, or both. Please see District Board policies 103 and 504.4 for additional information on available grievance procedures.