October 2019
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Application for Student-Initiated &
Led Organization
Under District Policy IGDA-Student Activities and Organizations
To be completed by a student or students of the sponsoring secondary school
Application Date:
Name of Proposed Organization:
Name of the student contact for the Organization:
Email address:
Proposed Employee Monitor:
Proposed Meeting Day(s) & Time(s):
(Note: Must meet during “non-instructional” time only. The period of time when lunch periods overlap with instructional periods is
considered to be instructional time)
Proposed Meeting Location:
Please describe the purpose of the organization:
Student Acknowledgements As the student(s) submitting this Application I/we acknowledge and agree to the
Membership in this organization will be voluntary and open to but limited to students currently enrolled i
my/our school.
Meetings of this organization that are conducted on school premises will not be directed, conducted,
controlled or regularly attended by non-school persons.
Information about the organization and notices of meetings will only be posted on the school website and o
bulletin boards and/or wall space designated by the principal, and postings shall be on District-approved forms
In conducting any activities, I/we may distribute notices and flyers and engage in other communications as
authorized in accordance with governing law and District policies/regulations, including but not limited to District
Policies KHB (District Revenue Through Advertising) and KHC (Distribution/Posting of Non-District
Communications), and I/we may identify ourselves as students from our school but will not represent that I/we
e sponsored, supervised or controlled by the District or my/our school.
I/We will not engage in any activity that is contrary to law, District policies/regulations or school rules; that
disrupts or clearly threatens to disrupt the orderly operation of the District or school; or that would adversely
affect the health, safety or welfare of any student or District employee.
Printed name(s) and signatures of student(s) submitting this Application (attach a separate sheet if necessary):
October 2019
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Employee Monitor Acknowledgements:
As Monitor of this Student-Initiated and Led Organization, I acknowledge and agree to the following:
I have read the Student Acknowledgments above and will ensure that the student-initiated and led
organization adheres to them.
I will serve as a monitor for purposes of general supervision at the Student-Initiated and Led Organization’s
meetings held at the school.
If the student-initiated and led organization’s meetings are religious in nature, I will be present in a
non-participatory capacity only.
I will not direct, conduct or control the meetings or activities of the student-initiated and led organization.
Proposed Employee Monitor- Sign AND Print Name
Principal Review:
Recommend Approval Recommend Approval with Changes Recommend Denying
Recommended changes (e.g. meeting location, days and/or times) or reason for denial:
Principal’s Signature: Date:
Regardless of your recommendation, forward this Application to Risk Management.
Risk Management Review:
Request complies with District Policy Request does not comply with District Policy
Comments, including where request is not compliant with District Policy:
Director of Records & Risk Management’s Signature: Date:
Assistant Superintendent Decision:
Approve as originally proposed Approve with required changes
Requirements, reason for denial or other comments:
Assistant Superintendent’s Signature: _ Date: