<p> Middleborough Public Schools’ Verification Form</p><p>This verification form will serve as evidence for the District and the Department of Elementary and Secondary Education that a staff member has reviewed and understands the materials presented for Mandated Training. (Click on each selection and complete) Date: Please type your full name. </p><p>Please use the pull down menu to select your school. Select School</p><p>Confidentiality I certify that I have read and understand the information presented regarding Confidentiality. Yes No Bullying Prevention & Intervention Plan I certify that I have read and understand the information presented regarding Bullying. Yes No Civil Rights & Section 504 I certify that I read and understand the information presented regarding Civil Rights. Yes No Student Records Procedures I certify that I have read and understand the information presented regarding Student Records Policy. Yes No Harassment Policy I certify that I read and understand the information presented regarding Harassment Policy. Yes No Sexual Harassment Policy I certify that I have read and understand the information presented regarding Harassment Policy. Yes No Physical Restraint Policy I certify that I have read and understand the information regarding Physical Restrain. Yes No Internet and Network Acceptable Use Policy I certify that I have read and understand the information presented regarding Internet and Network Acceptable Use Policy. Yes No English Language Learners Handbook I certify that I have read and understand the information presented regarding English Language Learners. Yes No Wellness Policy I certify that I have read and understand the information presented regarding Wellness Policy. Yes No Anaphylaxis Protocol I certify that I have read and understand the information presented regarding Anaphylaxis Protocol. Yes No Field Trip Protocol I certify that I have read and understand the information presented regarding Field Trip Protocol. Yes No Bloodborne Pathogens I certify that I have read and understand the information regarding Bloodborne Pathogens. Yes No </p><p>Should you require additional training in any of the mandatory areas, please indicate areas of interest:</p><p>Signature: ______Date: </p>