School District of Superior Confidentiality Training Agreement For Coaches, Interns, Student Teachers, and Long-Term Volunteers As a condition of your placement in the School District of Superior, you are expected to maintain strict levels of confidentiality as a professional. Please read and sign the following statement. I hereby confirm that I understand the confidential nature of school district students, their education, their records, and their family information; and that I will respect the confidentiality requirements under the HIPAA, ADA, and FERPA laws affecting this school district. I also understand that a violation of confidentiality will result in loss of placement within this district.

_________________________ Signature

__________________ College/University/Coach Position

_________________________ Printed Name

__________ Date

Circle one: I am: Intern

Student Teacher

Practicum Student

Long Term Volunteer

Coach

Return form to: Monica Tikkanen, Director of Human Resources Department C/O Kathy Stuart 3025 Tower Avenue Superior, WI 54880 (715) 394-8719 OTHER TRAINING: By your signature above you assert that you have completed the training listed below. The District believes your knowledge of the following topics will enhance your professional ability to serve students better. Please view the training on Harassment/Discrimination policies and DPI Podcast requirements on our website. Here are the steps to view the Harassment and Safety Training Manual and the DPI podcast: • • • • •

First, go to http://www.superior.k12.wi.us and look at the left hand tabs on the screen. You will left click on the Administrative Departments. Next, left click on Human Resources Department Scroll down to the section titled Forms. Under Forms, left click and open Harassment and Safety Training.pdf. Please Read it. Then Click on the DPI podcast under Human Resource Links. Watch the 16 minute podcast. Please print the certificate at the end and return it to the School District’s HR Department for your personal file.

You will have access to the information at any time by going back to the website. Any questions, call the Human Resources Department at 715-394-8719.

Created: December, 2006, Revised August, 2011, October, 2013