School – School Data Form | Diocese of Jefferson City

School – School Data Form

SCHOOL - 2023-2024 School Data Form

This form should be submitted to the Catholic School Office no later than September 16, 2023.

Name of School(Required)

Administrator Name(Required)

Email(Required)

Do you have an Assistant Principal?(Required)

Assistant Principal Name(Required)

Who is your Teacher-In-Charge?(Required)

Who is the School Secretary(ies)?(Required)

County:(Required)

Public School District(Required)

SCHOOL ADVISORY COUNCIL INFORMATION:

Please enter all contact information requested if you have it.

Name of School Advisory Council President:(Required)

Phone #

Email Address

Street Address

City

Zip Code

Number of CLERGY School Advisory Council Members:(Required)

Number of LAY School Advisory Council Members (Including President):(Required)

HOME AND SCHOOL INFORMATION:

Please enter all contact information requested if you have it.

Name of Home and School President:(Required)

Phone #

Email Address

Street Address

City

Zip Code

Grade levels included in your school:(Required)

Does your school have a four-day school week?(Required)

Which is the off-day?(Required)

If you have a four-day school week, do you provide childcare on the 5th day?(Required)

My school has:(Required)

(Check all that apply)

Before School Care

After School Care

Infant Care

None of Above

Is there a preschool?(Required)

What ages are preschool for?(Required)

Kindergarten is:(Required)

Does your school have a current Crisis Manual?(Required)

Does your school have documented lockdown procedures?(Required)

Does your school have regular lockdown drills?(Required)

Does your school have an AED machine?(Required)

How many AED machines?(Required)

Is there a school nurse?(Required)

Is the nurse full-time or part-time?(Required)

Does your school have a Counselor?(Required)

Does your school have a Special Education (SPED) teacher?(Required)

Does your school have a Learning Specialist?(Required)

STAFF ANNIVERSARY RECOGNITION INFORMATION:

School staff is recognized for the following milestones - 5, 10, 15, 20, 25, 30, 35, 40, 45, 50 years service COMPLETED.

Do you have any of the above mentioned service milestones to recognize?(Required)

Please list names and milestone year. (Click on + to add more rows)(Required)

Staff Member Name

Milestone Year to Recognize

Do you use a branded discipline/behavior program i.e. BIST, Restoration Matters, etc.?(Required)

Please enter the name of the branded program below:(Required)

Does your school have its own individualized discipline behavior program?(Required)

What mental health resources does your school offer?(Required)

Please describe clearly below. Include any resources provided for students, faculty and staff:

What extracurricular activities does your school offer?(Required)

Please list below: Click on + to add additional rows if needed. (In none, enter N/A)

Name of Activity

Grades Participating

Does your school have an IT Coordinator?(Required)

IT Coordinator Contact Information:(Required)

Name

Phone No.

Email Address

How does your school access the Internet?(Required)

Internet Access - Other:(Required)

Please explain.

If you use an E-Rate program, what service do you use?(Required)

E-Rate Service - Other:(Required)

Please explain.