Forms

Athletic Forms

Community Forms

Program Volunteer Affidavit	Must be filled out and include the documentation mentioned in order to help as a volunteer for the Northern Lebanon School District.
Right to Know Request Form	This form needs to be completed in order to request any school information to be released under the Right to Know Law.
Request to Address School Board Form	Complete this form in advance of a school board meeting to be allowed time to speak at the meeting.

Health Forms

Student Accident Insurance	Details voluntary student accident insurance available from A-G Administrators.
Student Physical Exam Form (English)	Pennsylvania Department of Health physical form for school students. (English version)
Student Dental Exam Form	Form to completed in order to provide record of a student's dental exam.
Student Medication Form	Request form for student to receive medication during the school day.

Student Physical

Exam Form (Spanish)

Pennsylvania Department of Health physical form for school students. (Spanish version)

Technology Forms

Parent-Student Agreement

This form is to be completed by parents and students at the beginning of each school year when devices are issued.

Student Device Handbook

Student Device

Handbook - Spanish

This is the handbook for all students describing the rules and procedures while using district devices and working on the network.

Student Device Insurance

This form should be completed by parents and submitted within the first few weeks of the school year.

Student/Parent Forms

Free and Reduced Lunch Application Spanish Free and Reduced Lunch Application	Complete and submit this form in order to apply for free or reduced lunch status for a student.
CTC Application	Form to be completed for a student to apply to attend or continue to attend the Lebanon County Career and Technology Center.
Address Change Request	Complete this form if a student is changing their home address.
Secondary Excused Trip Form	Form for excused pre-planned educational trip or medical absence - High School/Middle School students.
Elementary Excused Trip Form	Form for excused pre-planned educational trip or medical absence - Elementary students
Elementary Daily Excuse Absences	Use for Daily Absences for elementary students - submit to main office.
Graduate Transcript Request	For a graduated former student to request a transcript.
Graduation Project Log	Used to log graduation project hours.
Homecoming/Prom Guest Form	Must be completed prior to purchasing a ticket if you are bringing a guest from another school.
Student Transcript Request	For current students requesting a transcript.
Parent Release of Info Form	Complete this form to allow the school to release educational information of your student.
Parking Permit Application	Form for high school students to complete to apply for a parking permit.
Request for Attendance Exception Due to Child Care	Complete this form to apply for an attendance exception due to child care.
Student Assistance Team Referral	Students should fill out this form in order to refer another student to the Student Assistance Team.
Elementary Student Handbook (English)	Current/New policies and procedures for elementary schools.
Elementary Student Handbook (Spanish)	Current/New policies and procedures for elementary schools.
Secondary Student Handbook (English)	Current/New policies and procedures for the secondary schools.

2020-2021 PSSA/Keystone Testing Information for Parents and Guardians

Keystone Winter/Spring Opt-Out 2021

This is a building level testing schedule.

Keystone Winter Schedule - 2021

This is a building level testing schedule.

Keystone Test Dates - Spring 2021

Keystone Testing Schedules - Spring 2021

o Literature - Sections 1 and 2 - 05/19/21 (7:30 - 11:30 AM)

o Algebra I - Sections 1 and 2 - 05/26/21 (7:30 - 11:30 AM)

o Biology - Sections 1 and 2 - 06/02/21 (7:30 - 11:30 AM)

Information for Parents or Guardians

2020-2021

Answers to frequently asked questions regarding PSSA testing.

Pennsylvania Calculator Policy 2020-2021

PDE rules regarding calculator use during testing.

Code of Conduct for Test Takers 2020-2021

PDE do's and don'ts for students taking PSSA.

Electronic Device Information 2020-2021

PDE rules regarding use of cell phones, smartphones and other electronic devices during testing.

PSSA Opt-Out 2021

PSSA Test Dates - Spring 2021

· English Language - Section 1 and 2 - Grades 6, 7, 8 - Wednesday, 5/5/2021

· English Language - Section 3-Group A - Grades 6, 7, 8 - Thursday, 5/6/2021

· English Language - Section 3-Group B and full-time live stream and virtual students - Grades 6, 7, 8 - Friday, 5/7/2021

· Math - Section 1 and 2 - Grades 6, 7, 8 - Wednesday, 5/12/2021

· Science - Section 1 and 2-Group A - Grade 8 - Thursday, 5/13/2021

· Science - Section 1 and Section 2 - Group B and full-time live stream and virtual students - Grade 8 - Friday, 5/14/2021

· English Language - Grades 3-5 - Monday, 5/3/2021-Wednesday, 5/5/2021

· Math - Grades 3-5 - Thursday, 5/6/2021-Friday, 5/7/2021

· Science - Grade 4 - Monday, 5/10/2021-Tuesday, 5/11/2021

PSSA SPRING Testing Schedules - (SECONDARY Level)

Gr. 6, 7 & 8 ELA - 05/05/21 - Sect. 1 (7:30 - 9:45) and Sect. 2 (12:15 - 2:30)
Gr. 6, 7 & 8 ELA - 05/06/21 - Group A - Sect. 3 (7:30 - 9:45)
Gr. 6, 7 & 8 ELA - 05/07/21 - Group B - Sect. 3 and full-time live stream and virtual students (7:30 - 9:45)
Gr. 6, 7 & 8 Math - 05/12/21 - Sect. 1 (7:30 - 9:45) and Sect. 2 (12:15 - 2:30)
Gr. 8 Science - 05/13/21 - Group A - Sect. 1 (7:30 - 9:45) and Sect. 2 (12:15 - 2:30)
Gr. 8 Science - 05/14/21 - Group B - Sect. 1 and full-time live stream and virtual students (7:30 - 9:45) and Sect. 2 and full-time live stream and virtual students (12:15 - 2:30)

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Athletic Forms

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Health Forms

Technology Forms

Student/Parent Forms

2020-2021 PSSA/Keystone Testing Information for Parents and Guardians

Free Reduced Lunch Forms

COVID-19 Forms

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