CCPS "SAFE DATES" VIRTUAL PROGRAM
The “Safe Dates” Program provides information to students on safe relationships versus abusive relationships. This is composed of two-day two-hour bi-monthly virtual sessions These sessions are conducted according to the following schedule:

#1. September 8th and 15th, 2021.
#2. November 10th and 17th, 2021.
#3. January 12th and 19th, 2022.
#4. March 9th and 17th, 2022.
#5. May 4th and 11th, 2022.
Time: 6:00 pm to 8:00 pm.

The student and parent will need 2 devices in order to participate: laptop, tablet, cell phone, etc. There will be a session for the students as well as for the parents. After they have registered for the sessions, the parent and student will receive by email, the Zoom link for the session.

In the event of an emergency resulting in either the student or parent being unable to attend the program as scheduled, the principal of the student’s school should be notified immediately. A minimum of 5 students is required for the session to hold.

Disposition Code: 6180

*** Administrator, Please forward/Email copy of completed Referral Form to: CWOOTEN@SCSAC.ORG




ONLY ADMINISTRATORS MAY INITIATE REFERRALS TO ALTERNATIVES TO SUSPENSION PROGRAMS (ATS). CIRCLE OF SUPPORT MEMBERS MAY INTITIATE REFERRRALS/CHECK THE OPTION TO USE THE PROGRAM AS A PREVENTION MEASURE (PREVENTION-ALTERNATIVES TO SUSPENSION PROGRAMS: P-ATS)
Sign in to Google to save your progress. Learn more
Email *
Select the SESSION # you want to Attend *
SCHOOL NAME *
Today's Date *
MM
/
DD
/
YYYY
STUDENT'S FIRST AND LAST NAME *
STUDENT'S GRADE *
STUDENT'S HOME ADDRESS *
STUDENT DATE OF BIRTH *
MM
/
DD
/
YYYY
STUDENT HOME LANGUAGE *
STUDENT EMAIL ADDRESS (REQUIRED) *
PARENTS/GUARDIAN'S FIRST AND LAST NAME *
PARENT/GUARDIAN EMAIL ADDRESS (REQUIRED) *
PARENT/GUARDIAN PHONE #
STUDENT CODE OF CONDUCT ITEM. Write "NA" if referral is for Prevention. *
STUDENT AGREEMENT: I have accepted the option given to me by the Clayton County Board of Education to participate in the “SAFE DATES” program indicated. In accepting this opportunity, I agree to abide by the guidelines and other conditions set forth in this program. I understand that up to five (6) days of suspension may be taken from my total suspension period for the above offense. I understand that if I do not log in and complete the program, I will be terminated from the program and the assigned days of suspension will be enforced. *
Parent AGREEMENT: As parent or guardian of the above named student, I agree to support and ensure that my son/daughter logs in and completes the "Safe Dates" Program as assigned in order to give him/her the opportunity to continue his/ her educational program in the virtual classroom. *
FIRST AND LAST NAME OF ADMINISTRATOR/ CIRCLE OF SUPPORT INITIATING REFERRAL *
Next Step: After you Submit the Referral Form, you will automatically receive a copy of the referral you submitted in your Email. You must FORWARD a copy of this electronic Referral to the Program Contact/Facilitator and Parent to confirm Registration for the Program sessions. *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Clayton County Public Schools. Report Abuse