District Policies, Procedures, and Forms

Salem-Keizer Public Schools has chosen a Quality Assurance Model (QAM), a continuous improvement process, that demonstrates our commitment to our students. Through a constant commitment to QUALITY, we provide a pathway to success for every child, every day.

Accessible Athletics for Transgender, Nonbinary, and Gender Nonconforming Students ♦ INS-P040
Description: Athletics will be accessible to all students, including transgender, nonbinary, and gender nonconforming students.

Available options: This document is available in English | Russian | Spanish | Swahili.

Accessible Facilities for Students and Staff of all Genders ♦ FAC-P022
Description: Students, staff, and district visitors shall be provided access to gender-specific facilities at school consistent with their gender identity. Access to private facilities based on privacy, safety, or other concerns will also be made available to the extent possible.

Available options: This document is available in Arabic | English | Russian | Spanish | Swahili.

Asthma Treatment Plan ♦ HST-F006
Description: This form is completed by District personnel and a student's parent. It provides basic information about asthma triggers, symptoms, and hospitalizations.

Attendance Policy ♦ INS-A009
Description: Official attendance policy of the district.

Available options: Document is a vailable in English | Russian | Spanish.

Authorization to Use or Disclose Protected Information ♦ INS-F078
Description: used to request a release of student information.

Available options: Document is available in English | Spanish.

Bias Incidents and Symbols of Hate (Every Students Belongs) ♦ ADM-A012
Description: All students, employees, and visitors in the Salem-Keizer School District are entitled to learn, work, and participate in an environment that is safe and free from discrimination, harassment, and intimidation. The District is committed to providing a safe and welcoming environment for all.

Available options: This document is available in English | Russian | Spanish | Swahili.

Bullying Policy, Poster Version
Description: Official, text-only poster outlining the district's bullying policies in INS-A003; legal-sheet size.

Available options: Poster is available in English | Spanish.

Bus Rules ♦ TRN-A005
Description: Salem-Keizer rules governing students riding school buses and school activity vehicles (581-053-0010).

Community Transition Programs Brochure ♦ STS-W037
Description: brochure explains the CTP program and its locations.

Available options: Document available in English | Spanish.

Complaints: Discrimination against Student with Disabilities ♦ STS-P005
Description: Explains parent's rights under section 504 and what they can do if they have a complaint.

Available options: Document is available in English | Spanish.

Compulsory Attendance ♦ INS-A010
Description: A child who is considered a resident of Oregon shall receive a free and appropriate education from the district in which the child resides. Except as provided in ORS 339.030, all children between the ages of 7 and 18 years who have not completed the 12th grade are required to attend regularly a public full-time school of the school district in which the child resides.

Available options: Document is available in English | Spanish.

Contractor Release & Authorization Form ♦ HUM-F025
Description: Authorization for background check for contractors working in Salem-Keizer schools.

Available options: Contractors can use the online application for adult contractors or download and fill out a PDF in English | Spanish

COVID-19 Testing Consent Form ♦ HST-F016
Description: Form gathers parent/guardian permission for students to participate in COVID-19 testing onsite.

COVID-19 Testing in SKPS K-12 Schools ♦ HST-W018
Description: Guidelines for COVID-19 testing onsite and reporting of the COVID-19 communicable disease within the student and staff population at Salem-Keizer Public Schools (SKPS). SKPS will follow the OHA COVID-19 Testing in Oregon’s K-12 Schools. SKPS will work collaboratively with LPHA and OHA during the communicable disease or virus outbreak process. This work instruction and all addendums attached, provide the framework for the districts COVID-19 testing response. The District Health Authority (DHA) and onsite testing team will be the liaison between SKPS and the LPHA and OHA for communicable disease response for COVID-19 testing.

Criminal History Check – Paid Student Workers ♦ PAP-F023
Description: This application is for all Salem-Keizer School District student workers.

Available options: Document is available in Arabic | English | Russian | Spanish | Swahili.

Criminal History Check Packet ♦ PAP-F003
Description: For adults wanting to volunteer in Salem-Keizer schools.

Available options: Apply using the online form or download the form, available in Chuukese | English | Marshallese | Russian | Spanish.

Custom Requisition ♦ REP-F002
Description: Fillable PDF to order custom projects from Reprographics.

Available options: Learn more about the Reprographics Print Shop.

Daily Medication Administration ♦ HST-W004
Description: Informs school staff and parents of rules applicable to administration of medications to students.

Available options: The instructions are in English and Spanish on this same document.

Diploma Options / Tipos de diplomas ♦ INS-M012
Description: Alternate diploma options explained (modified, extended diploma, certificate requirement) -

Available options: This one PDF booklet contains both English & Spanish.

Dress Code: Student ♦ INS-A025
Description: The District's current dress code policy for students.

Available options: Document is available in Chuukese | English | Russian | Spanish.

Entrance Age Policy ♦ INS-A006
Description: Entrance age requirements for admittance of children entering kindergarten and first grade.

Available options: Document is available in English | Spanish.

Equal Educational Opportunity ♦ ADM-A009
Description: The District's commitment to equal educational opportunities and treatment for all students is outlined in this administrative policy.

Available options: Document available in English | Spanish.

Equal Employment Opportunity ♦ HUM-A017
Description: The commitment of the District to ensure equal employment opportunities and treatment, and to prevent discriminatory practices. (Replaces legacy policy GAAA.)

Available options: Document available in English | Spanish.

Equity ♦ ADM-A010
Description: Describes the District's committed to equity for all students.

Every Student Belongs Poster ♦ ADM-A012
Description: Poster version of ADM-A012 policy which holds that all students, employees, and visitors in the Salem-Keizer School District are entitled to learn, work, and participate in an environment that is safe and free from discrimination, harassment, and intimidation. The District is committed to providing a safe and welcoming environment for all.

Available options: This poster is available in English | Spanish.

Facility Rental Customer Information Form ♦ FAC-F047
Description: Form for customers information needed in order to rent indoor space within the district.

Facility Rental Event Request ♦ FAC-F048
Description: Fill out this form to request permission to rent a district facility and estimate the charges.

Facility Rental Fee Schedule ♦ FAC-W028
Description: A list of current rental fees for district facilities, including both indoor and outdoor rental fees.

Federal Programs Manual ♦ ISS-M005
Description: This guide documents the manner in which we serve students through the use of Federal, state, and local grants in Salem-Keizer Public Schools (SKPS or the District). The District utilizes funding from each of these grant sources for the benefit of our most vulnerable learners in pursuit of a well-rounded educational experience for all.

Fingerprint Requirements for New Employees ♦ HUM-W023
Description: fingerprint requirements for new employees

Graduation Requirements ♦ INS-A032
Description: Classes and credits needed to meet the State Board of Educations' requirements to receive a high school diploma.

Available options: Document available in English | Spanish.

Guidance for Coaches ♦ PAP-W021
Description: Provides guide lines for deciding when and how to physically assist students in the coaching environment.

Guide to Staff-Student Interaction ♦ HUM-W039
Description: Brochure for parents/guardians that describes expected interactions between employees/volunteers and students as well as the steps for reporting concerns.

Guidelines for Attendance and Physical Activity in School ♦ HST-F018
Description: form for health care providers to fill out for releasing students back into PE and sports participation

Hazing, Harassment, Intimidation, Bullying, Cyberbullying and Menacing: Student ♦ INS-A003
Description: District policy on bullying and harassment involving students.

Available options: The policy document is available in English | Russian | Spanish or get the legal-size poster in English | Spanish

Immigration Officials and Other Non-Local Law Enforcement: School Response ♦ INS-A035
Description: Policy for district interaction with non-local law enforcement.

Available options: Document available in English | Spanish.

Immunization Requirements ♦ HST-W002
Description: Student immunization requirements by grade level. Document has both English and Spanish.

In-District Transfer Form, Elementary ♦ INS-F018
Description: Request form to transfer a K-5th grade Salem-Keizer student to a different elementary school within the school district. In-district transfers open twice a year, in March and November.

Available options: Visit the Student Transfers webpage for more information. This form is available in English | Spanish.

In-District Transfer Form, High School ♦ INS-F046
Description: Request form to transfer a 9th-12th grade Salem-Keizer student to a different high school within the school district. In-district transfers open twice a year, in March and November.

Available options: Visit the Student Transfers webpage for more information. The form is available in English | Spanish.

In-District Transfer Form, Middle School ♦ INS-F044
Description: Request form to transfer a 6th-8th grade Salem-Keizer student to a different middle school within the school district. The in-district transfer option is open twice a year, in March and November.

Available options: Visit the Student Transfers webpage for more information. This form is available in English | Spanish.

In-District Transfer Request Process for Elementary Students ♦ INS-P011
Description: Criteria and process to be followed to request permission for elementary age students to attend a District school other than the one within their regular attendance boundary.

Available options: Document is available in English | Spanish.

In-District Transfer Request Process for High School Students ♦ INS-P015
Description: Criteria and process to be followed to request permission for high school students to attend a District school other than the one within their regular attendance boundary.

In-District Transfer Request Process for Middle Schools Students ♦ INS-P012
Description: Criteria and process to be followed to request permission for middle school students to attend a District school other than the one within their regular attendance boundary.

Instructional Materials Selection Administrative Policy ♦ CUR-A001
Description: Outlines the basic principles of instructional materials and curriculum selection.

Available options: Document is available in Arabic | English | Spanish.

Instructional Materials Selection Procedure ♦ CUR-P001
Description: Process to select instructional materials and curriculum for elementary programs and secondary courses.

Available options: Document available in English | Spanish.

Integrated Pest Management Plan ♦ RSK-M006
Description: District policies and procedures relating to the application of pesticides and herbicides on school grounds.

Available options: Document is available in English | Spanish.

Intent to Renew for Non-Resident Transfers ♦ INS-F024
Description: Form for students who are not residents of Salem-Keizer 24J School District and want to renew their transfer from another school district.

Available options: Form available in English | Spanish.

Internet Filtering ♦ TIS-A004
Description: District policy to prevent access to inappropriate material via the Internet.

Investigating Reports of Bias Incidents and Symbols of Hate Poster ♦ ADM-P010
Description: Process for reporting and investigating bias incidents and symbols of hate. The terms “bias incidents”, “symbols of hate” and “persons impacted” are defined in Administrative Policy ADM-A012.

Available options: Document available in English | Spanish.

Investigating Reports of Student Hazing, Harassment, Intimidation, Bullying, Cyberbullying and Menacing ♦ INS-P006
Description: Describes the process for reporting and investigating hazing, harassment, intimidation, bullying, cyberbullying and menacing involving students.

Available options: Document available in English | Spanish.

Investigation by Law Enforcement Agencies ♦ INS-A033
Description: Policy for district interaction with police officers investigating a case.

Available options: Document available in English | Spanish.

LGBTQ+ Affirming Education ♦ INS-P039
Description: District staff and teachers, program associates, and administrators will create an inclusive and encouraging environment for students of all genders and sexualities.

Available options: This document is available in Arabic | English | Russian | Spanish | Swahili.

Lice Notification to Parents, Sample Letter ♦ HST-F008
Description: Word template with suggested wording to notify a parent of head lice on their student

LPHA Communicable Disease Line List ♦ HST-F014
Description: List used for contact tracing. Consult nurse help line for assistance.

Maintaining Appropriate Staff/Student Boundaries ♦ PAP-W006
Description: This brochure provides guidance for staff to establish boundaries with students.

Available options: Available in a web-friendly booklet (English) or a trifold brochure (English).

Maintaining Appropriate Volunteer/Student Boundaries ♦ PAP-W016
Description: Expectations for volunteers to follow when interacting with students.

Available options: This document is available in Chuukese | English | Spanish.

McKinney-Vento Program ♦ ISS-W018
Description: Brochure with contacts, information, and resources for homeless students and families.

Available options: Brochure is available in English | Marshallese | Spanish.

Media Relations ♦ COM-A001
Description: describes how Salem-Keizer Public Schools, through the Community Relations and Communications department, will respond and cooperate with professional news media.

New Employee Orientation Policies ♦ HUM-M008
Description: policies and administrative rules applicable to Licensed and Classified employees

New Employee Password Set-up ♦ TIS-W024
Description: Instructions for a new employee to set their computer, email, Office 365 password.

Options Brochure ♦ INS-M007
Description: Brochure describes flexible academic programs available to students who need more structure and guidance.

Available options: Brochure is available in English | Spanish.

Out of District Transfer Application ♦ INS-F023
Description: Form for students outside of Salem-Keizer School District 24J boundaries who wish to attend a school within this district.

Available options: Form available in English | Russian | Spanish.

Pandemic Flu and Infectious Disease ♦ HST-M001
Description: provides guidance to district leadership and staff in the event of a pandemic outbreak in the Salem-Keizer Public Schools (SKPS) or the region.

Parent’s Guide to Section 504 of the Rehabilitation Act ♦ STS-W008
Description: Handbook explains 504 plans, identification, process, and parent rights.

Placement of Portable Toilets ♦ FAC-W031
Description: Guidelines for pre-approved temporary placement of portable (chemical) toilet on school district property by community groups or district programs.

Portable Toilet Placement Request ♦ FAC-F052
Description: Use this form to give a detailed description and quantity of portable toilet placement proposed for a district school or site.

Preparing for and Administering Breathalyzer Tests ♦ INS-W050
Description: This work instruction describes the steps to prepare for and administer breathalyzer tests at school-sponsored major events including prom and homecoming. Students and guests will be randomly tested according to policy INS-A015-Student Search and Seizure.

Protecting Transgender Student Privacy ♦ INS-P038
Description: Steps that district staff should take in order to protect the privacy of a student when they wish to affirm their identity at school as two-spirit, transgender, nonbinary, or another gender nonconforming identity.

Available options: This document is available in Arabic | English | Russian | Spanish.

Provider Report and Treatment Orders ♦ HST-F020
Description: Physician's authorization for administration of specialized physical health care services. Fax filled out form to Student Services at 503-316-3500.

Public Complaints: Process for Resolving ♦ ADM-A008
Description: Procedure for bringing complaints of discrimination to the district's notice for investigation.

Available options: Document available in English | Spanish.

Public Record Requests ♦ ADM-P002
Description: Details the process to request inspection or copies of Salem-Keizer School District public records.

Available options: Document available in English | Spanish.

Pupil Medical Record ♦ HST-F003
Description: Pupil medical record form.

Available options: Form is available in English | Spanish.

Radon Testing Work Instructions ♦ RSK-W029
Description: Procedures to be taken to test District owned and/or occupied buildings for radon.

Reconsideration of Library and Instructional Materials ♦ CUR-P004
Description: Outlines the steps that a parent, guardian, or community member would take to request reconsideration (exclusion) of instructional materials.

Release of Ill or Symptomatic Student ♦ HST-W017
Description: Process for staff to follow when a student displays signs of infection illness consistent with COVID-19.

Available options: Document available in English | Spanish.

Reporting During Inclement Weather and Other Emergencies ♦ HUM-A002
Description: Based on job classification, outlines what actions district staff should take when there is inclement weather or emergencies that cause a delayed school start, school closure, early release, and district closure

Reports of Sexual Harassment Investigation: Students ♦ INS-P032
Description: Process for reporting and investigating sexual harassment involving students.

Available options: Document is available in English | Russian | Spanish | Swahili. See INS-F082 for sample letter.

Request for Reconsideration of Library and Instructional Material Form ♦ CUR-F019
Description: This form is used to lodge complaints about instructional materials and request their removal from a school.

School Supply Recommendations ♦ INS-W019
Description: Recommendations for the most common school supplies needed for students in kindergarten through high school.

Available options: Document available in English | Marashallese | Russian | Spanish.

School Volunteers Policy ♦ PAP-A003
Description: Outlines the district's school volunteer policies.

Search and Seizure of Students ♦ INS-A015
Description: School officials have the authority to conduct searches of District property and the personal property of students based upon reasonable suspicion, and to seize unauthorized, illegal or unsafe materials, and/or identify unsafe conditions as a proactive response to keeping schools safe.

Seizure Treatment Orders ♦ HST-F019
Description: Physician's authorization for administration of seizure management at school. Fax filled out form to Student Services at 503-316-3500.

Severe Allergy and Anaphylaxis Emergency Care Plan ♦ HST-F007
Description: This form outlines signs and symptoms of systemic (anaphylactic) reactions for an individual student and provides response directions.

Sexual Harassment Employee 3rd Party Notice Letter ♦ HUM-F047
Description: Sample employee/third party notification letter related to sexual harassment reports.

Available options: This Word document is available in English | Russian | Spanish | Swahili.

Sexual Harassment Employee-Third Party Notice – Reported Person ♦ HUM-F049
Description: Sample letter for notice to employees and third parties on the results of a sexual harassment investigation.

Available options: Word document is available in English | Russian | Spanish | Swahili.

Sexual Harassment Parent-Student Notice ♦ INS-F082
Description: Example letter of notice to parents and students parties about a harassment investigation.

Available options: Word document available in Arabic | English | Russian | Spanish | Swahili.

Sexual Harassment Policy ♦ HUM-A029
Description: The district’s policy is to maintain a work and educational environment that is free from harassment related to a person’s gender or sexual orientation.

Available options:

Sexual Harassment Student-Guardian Notice – Reported Person ♦ INS-F083
Description: Sample letter to a person reported to have violated the district's sexual harassment policy.

Available options: Word document available in Arabic | English | Russian | Spanish.

Site and Ballfield Modification Request ♦ FAC-F051
Description: Fill out this form to request changes to school district sites or ballfields.

Social Media Accounts ♦ INS-W036
Description: explains how school sponsored social media accounts are requested, created, and maintained.

Social Media Guidelines ♦ COM-A004
Description: Through a variety of social media channels, Salem-Keizer Public Schools communicates information about the District and its schools to raise awareness of its services and activities and to communicate with the Salem-Keizer community. These channels are not intended to be public forums covering all topics.

Special Education & Related Services Brochure ♦ STS-W009
Description: This brochure itemizes special education services provided by the Student Services department.

Available options: The brochure is available in English | Russian | Spanish | Swahili.

Student Acceptable Use of Electronic Resources ♦ INS-A004
Description: Rules for student use of electronics for academic and personal use within the District such as computers, tablets, smart phones, peripherals, networks, email, telecommunications, and internet connections.

Available options: Document is available in Arabic | Chuukese | English | Spanish | Swahili.

Student and Parent Concussion Statement ♦ INS-F071
Description: Statement for parents and students to sign showing that they understand the risks of concussions and how to take care if a concussion occurs.

Available options: Form is available in English | Spanish.

Student Discipline Procedure ♦ INS-P028
Description: Describes the discipline process for student conduct and behavior issues. Also describes offenses and applicable consequences.

Available options: This document is available in English | Russian.

Student Education Records and Information ♦ INS-A011
Description: Administrative policy on the sharing of student information.

Student Fees ♦ INS-A012
Description: Administrative policy outlining what fees students might be charged and how the district can pursue collection.

Student Registration Form ♦ INS-F003
Description: This form is used to register a student in school.

Available options: Form is available in Chuukese | English | Russian | Spanish.

Student Report of Harassment and Bullying ♦ INS-F030
Description: Confidential form for a student to fill out in the case of harassment or bullying.

Available options: Form is available in English | Spanish.

Student Rights & Responsibilities Handbook ♦ INS-M001
Description: District handbook for students and a summary of discipline offenses & consequences.

Available options:

Document is available in Chuukese | English | Russian | Spanish or visit the Student Rights & Responsibilities Handbook webpage.

Student Volunteer Criminal History Check Summary ♦ PAP-F007
Description: Form for individuals under 18 years old who want to be Salem-Keizer volunteers.

Available options: Form is available in English | Marshallese | Russian | Spanish.

Student-Teacher Policy Agreement ♦ PAP-F020
Description: This packet is used to assure that student teachers are familiar with policies related to their service at the District.

Suicide Prevention and Intervention Policy ♦ INS-A038
Description: This policy covers actions that take place in the school, on school property, at school-sponsored functions and activities, on school buses or vehicles and at bus stops, and at school sponsored out-of-school events where school staff are present.

Suicide Prevention Protocol Preface ♦ INS-P037
Description: Cover letter included with INS-A038 sent to students and families.

Available options: SKPS Suicide Risk Assessment Policy and Procedure Preface document is available in English | Spanish.

TAG Parent Handbook ♦ TAG-M002
Description: This handbook provides parents with information about the Talented & Gifted Program and Services.

Available options: Handbook is available in English |Spanish or visit our web page for additional information on the TAG program.

Teen Dating Violence Policy ♦ INS-A013
Description: The process for reporting teen dating violence that occurs at school, on school grounds, at school-sponsored activities and in vehicles used for school-provided transportation.

Available options: Document is available in English | Russian | Spanish.

Tile IX Grievance Procedure ♦ HUM-P020
Description: This procedure outlines for steps the District will follow to receive, investigate, and resolve complaints of Title IX sexual harassment involving students and/or staff.

Available options: This document is available in English | Spanish.

Title IX ♦ HUM-A036
Description: Title IX of the 1972 Educational Amendments of the Civil Rights Act of 1964 states in part that, “No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving Federal financial assistance.” Salem-Keizer School District Administration is committed to providing educational and employment opportunities that are free from discrimination based on sex, and promptly investigating reported violations.

Available options: This document is available in Arabic | English | Marshallese | Spanish.

Transgender, Nonbinary, and Gender Nonconforming Student Student Equity ♦ INS-A040
Description: Salem-Keizer's commitment to the overall safety, wellbeing, education, and success of two-spirit, transgender, nonbinary, and gender nonconforming students.

Available options: This document is available in Arabic | English | Russian | Spanish | Swahili.

Transportation Discipline for Misconduct Related to School Bus ♦ TRN-A006
Description: Describes discipline for misconduct related to student transportation.

Transportation Guide for Parents of Children in Special Programs ♦ TRN-W023
Description: This guide has been designed to provide parents with general information regarding transportation for students with special needs.

Available options: Document is available in English | Spanish.

Two-Way Immersion Application ♦ ISS-F068
Description: This form gathers information necessary to place a student in the two-way immersion program.

Available options: Available in English | Spanish.

Visitors to Schools and Campus ♦ INS-A024
Description: Any individual who wishes to visit a school of the District shall be permitted to do so subject to the conditions contained in this policy.

Available options: Document is available in Arabic | Chuukese | English | Russian | Spanish.

Volunteer Frequently Asked Questions ♦ PAP-W011
Description: This work instruction provides answers to questions commonly asked by volunteers about the application process.

Available options: This document is available in Chuukese | English | Marshallese | Russian | Spanish.

Volunteer Handbook ♦ HUM-F046
Description: Handbook helps volunteers know the do's and do not's, important policies, and answers common questions.

Available options: Document is available in English |Russian | Spanish | Swahili.

Volunteer Letter ♦ PAP-W010
Description: This is a form letter that provides instructions about becoming a volunteer at the District. This letter is available in multiple languages.

Available options: Document is available in Chuukese | English | Marshallese | Russian | Spanish.

Waiver of Liability and Hold Harmless Agreement ♦ FAC-F049
Description: Waiver of liability and hold harmless agreement for use of indoor and outdoor facilities.

Wellness Policy and Procedure ♦ FNS-A001
Description: Policy outlines the district's responsibility within the school day to provide students with healthful food options, physical activity, and health education programs that promote lifelong well-being.

Available options: Document is available in English | Spanish. See also Wellness Procedure (FNS-P002) policy.

Youth Resources for Homeless Students ♦ ISS-W023
Description: McKinney-Vento Program brochure with information on meal sites, shelters, medical, family, education, emergency assistance, employment, food/clothing, housing, legal, social services.

Available options: This brochure is available in English | Spanish.

District Policies, Procedures, and Forms

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Equal Opportunity Statement

Staff Quick List