Forms, Plans & Notifications

• Forms
• Building Request Form
• Dignity for All Students Act (DASA) & Bullying Reporting Form
• Health Forms (Medical & Dental, Medication)
• SchoolTool Permission Form
• Tech Help Request Form
• Transportation Change Request Form
• Plans & Required Annual Notifications
• Academic Intervention Services (AIS) Violations
• Acceptable Use of Technology
• American Rescue Plan and Foundation Aid Plan
• Annual Professional Performance Review (APPR) and Obtaining Teacher/Principal APPR Scores
• Asbestos
• Attendance Policy
• Child Abuse Hotline
• Closings & Delays
• Data Privacy and Security
• District Comprehensive Improvement Plan
• Fire Inspection
• Grade Promotion and Placement
• Hand Sanitizer Use
• Instructional Technology Plan
• Lead Testing
• McKinney-Vento Homeless Assistance Act
• Pesticide Use
• Release of Student Information & Family Educational Rights and Privacy Act (FERPA)
• School Comprehensive Education Plan
• School Safety Plan
• Smart Schools Investment Plan
• District Policy Manual & Student Handbooks

The district’s COVID-19 Reopening FAQ is also listed at the bottom of this page.

Forms

Building Request Form

Request use of a district building via the Building Request Form below.

• Building Request Form (via Google Forms)

Contact the Building & Grounds Department with questions about using school buildings.

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Dignity for All Students Act (DASA) & Bullying Reporting Form

The district is committed to promoting civility throughout the school and creating an environment that is free of discrimination, harassment, bullying, and cyberbullying. Learn more about DASA and bullying behavior.

• Complete an anonymous DASA Reporting Form online
• Download and print a Bullying – Harassment – Discrimination Report Form

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Health Forms (Medical & Dental, Medication)

New York State law requires a physical exam for new entrants and students entering grades Pre–K or K, 1, 3, 5, 7, 9 & 11; for sports; working papers; or as required by the Committee on Special Education (CSE) or Committee on Pre–School Special Education (CPSE). A dental certificate which states your child has been seen by a dentist or dental hygienist is also asked for at the same time.

• Health Examination Form
• Dental Health Certificate

Any medication that has to be taken by a student during school hours or during school activities, even if it’s over-the-counter medication (non-prescription) requires a doctor’s order and written permission from a parent.

• Permission to Administer Single Medication

Learn more about Health Services.

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SchoolTool Permission Form

To sign up for the SchoolTool Parent Portal, please download and print the form below.

•  Request for Permission to Access SchoolTool/Parent Portal form

Visit the Parent Communications page for additional options on staying in touch with the district.

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Tech Help Request Form

Help is available for trouble with logins, passwords or accounts, devices such as Chromebooks or iPads, platforms such as Google Classroom or Google Meet, connecting to WiFi, and more. Learn more about the Technology Department and how technology is used to support learning.

• Tech Help Request Form

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Transportation Change Request Form

Your child must be registered with the district before you can request bus transportation. To change your child’s transportation, complete the below form.

• Transportation Change Request Form

Visit the Transportation page for more information about district transportation.

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Plans & Required Annual Notifications

State and federal laws require school districts to notify residents, parents/guardians, employees and others about policies and actions related to nearly all aspects of operating a school district. Some notifications are disseminated via the district website, displayed in buildings, and/or printed in publications such as student handbooks or the district calendar. Information about required annual notifications to be provide online are listed below. Questions may be directed to the District Office at (315) 866-2230.

Academic Intervention Services (AIS) Violations

Districts are required to provide a link to the NY State Education Department’s Written Complaint and Appeal Procedures webpage for filing a complaint or appeal concerning Academic Intervention Services (AIS) violations. Learn more about our Academic Intervention Services on our Special Programs page.

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Acceptable Use of Technology

Herkimer CSD is committed to the goal of having electronic network facilities used in a responsible, efficient, and legal manner. Learn more about acceptable use on our Technology page.

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American Rescue Plan and Foundation Aid Plan

The 2021-22 enacted New York State budget included language for the 2021-22 school year stating that each school district receiving a foundation aid increase of more than 10 percent, or $10,000,000, must post to its district website prior to July 1 of each school year a plan for the use of these funds to address student performance and need. Learn more about how the district uses American Rescue Plan funding on our Fiscal Transparency page.

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Annual Professional Performance Review (APPR) and Obtaining Teacher/Principal APPR Scores

Under the Every Student Succeeds Act, parents/guardians have the right to know the professional qualifications and Annual Professional Performance Review (APPR) of their child’s classroom teachers. Visit the Teacher Qualifications & Evaluations page for more information and to view Herkimer CSD’s APPR Plan.

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Asbestos

In accordance with the Asbestos Hazard Emergency Response Act of 1987 (AHERA), a copy of the Herkimer High School building inspection report and management plan is available for review during business hours by appointment. Learn more about our asbestos reporting.

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Attendance Policy

The Board of Education, administration and staff of the district recognize that regular classroom attendance is an essential part of a successful educational program and that there is a critical relationship between academically engaged time and student performance.

• View the Board Policy #7006 Student Attendance

Contact the Elementary School or the Middle-High School to report an absence. Learn when to keep your child at home on our Health Services page.

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Child Abuse Hotline

If you suspect a child is being abused or maltreated (neglected), report it by calling (800) 342-3720, a toll-free 24-hour hotline operated by the New York State Office of Children and Family Services. If you believe a child is in immediate danger, call 911 or your local police department. Information about reporting child abuse and maltreatment (neglect) is available online at https://ocfs.ny.gov/programs/cps/.

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Closings & Delays

Learn how the district communicates about closings and delays on the Closings & Delays page.

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Data Privacy and Security

New York State Education Law gives you the right to information about how Herkimer Central School District is safeguarding student and staff data.

• View the Board Policy #5306 Protection of Student, Teacher and Principal Personal Information (Data Security and Privacy)

Learn more about how district efforts to protect data on our Technology page.

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District Comprehensive Improvement Plan

The District Comprehensive Improvement Plan (DCIP) is one in which school districts work with stakeholders to consider existing needs and determine next steps for the upcoming school year.

• View Herkimer CSD’s District Comprehensive Improvement Plan (DCIP)

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Fire Inspection

All school buildings must be inspected for fire safety at least annually. Fire Inspection reports are available at the office of Herkimer Central School District at 801 W. German Street, Herkimer, NY 13350 for inspection by all interested persons.

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Grade Promotion and Placement

Promotion or retention of a student is based on a study of various information. Learn more on our Grade Promotion and Placement page.

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Hand Sanitizer Use

The Herkimer CSD will be making alcohol-based hand sanitizers available in its school buildings. If parents/guardians wish to opt their child out of using it, they should send a written notice to the school’s principal.

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Instructional Technology Plan

It is the vision of Herkimer Central Schools that students be engaged in a stimulating academic environment and a rigorous curriculum that is student-centered and focused on inquiry-based learning.

• Instructional Technology Plan

Learn more about how technology is used to support learning on the Technology page.

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Lead Testing

Herkimer Central School is committed to providing a safe environment for students, staff and guests. In accordance with recent state legislation, the district conducts periodic testing for lead in all water outlets that could be used for drinking or cooking. Learn more on our Lead Testing page.

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McKinney-Vento Homeless Assistance Act

McKinney-Vento provides federal funding to states for the purpose of supporting district programs that serve homeless students. Learn more about McKinney-Vento Homeless Assistance Act services on the Enrollment/Student Registration page.

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Pesticide Use

New York State Education Law requires all public and nonpublic elementary and secondary schools to provide written notification to all persons in parental relation, faculty, and staff regarding the potential use of pesticides periodically throughout the school year.

Learn more about district pesticide use and being notified of pesticide application.

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School Safety Plan

Emergencies and violent incidents in schools are critical issues that must be addressed in an efficient and thoughtful manner. The district’s plan is designed to prevent or minimize the effects of serious violent incidents and emergencies, as well as facilitating the coordination of the district with local, county, and state resources.

• District Wide School Safety Plan

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