Avery County Schools' Manual

        For

Random Drug Testing of

      Students




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                    Avery County Schools Random Drug/Alcohol Testing Policy

I. General Policy Statement The Avery County Board of Education strongly believes that drug and alcohol abuse can be detrimental to the physical and emotional health and the academic performance of its students. Furthermore, the Board believes that high school athletes, cheerleaders, and other students participating in extracurricular activities are representatives of the school system and are often role models for other students and, therefore, have great influence on other students. It is from this rationale and out of concern for students’ well-being and safety that a random student drug testing program is being initiated in the Avery County school system. The goal of the random drug-testing program is to help students by deterring and eliminating the use of illegal and/or controlled substances in its schools.

II. Administration

  A.     All students in grades 9-12 who desire to participate in any of the following voluntary
         school activities must agree to participate in the random student drug testing program:

         1.   Interscholastic athletics;
         2.   All competitive, extra-curricular activities;
         3.   All elective clubs (clubs that have no impact on a student’s grade);
         4.   Students seeking a parking permit on campus;
         5.   Students who volunteer to enter the program as set forth below.

         Hereinafter, these activities will be referred to as "voluntary activities", as the Board
         believes participation in these activities is a privilege, not a right.

  B.     To be eligible to participate in the voluntary activities, the student and his/her parents or
         legal guardians must participate in the random drug-testing program. Participation in the
         random drug-testing program shall not be required as a condition of attending school,
         enrolling in any class, or participating in any activity that receives a grade recorded on the
         student’s transcript.

  C.     Any parent of a student in Avery County Schools may consent to the student voluntarily
         participating in the random drug testing program, whether or not the student is a participant
         in any of the voluntary activities listed above. The same procedures will apply, as outlined
         in this policy, for all students participating in random student drug testing. Furthermore, any
         parent of a student in Avery County Schools may request when their student is tested as
         well. Any test performed pursuant to this section may be billed directly to the parents
         requesting random drug testing of the student.

  D.     The Superintendent or his designee shall develop a plan by which students may volunteer to
         be placed in a random drug/alcohol testing pool in accordance with this policy.

  E.     The administration shall prepare a Drug Testing Consent Form (RDT Form 1) to be signed
         by the student and the student’s parent/guardian. The parent/guardian shall be given a copy
         of the signed Consent Form and this Random Student Drug Testing policy. The original
         Consent Form shall be kept in the student’s official file.


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   F.     Students who desire to participate in the voluntary activities or privileges covered by this
          program shall sign the Consent Form prior to the beginning of the voluntary activity (e.g.
          sport season, athletic practice, at the beginning of the school year). The Consent Form will
          authorize random drug testing throughout the student’s entire school career in Avery County
          Schools, unless the student and parent revokes consent as set forth below.

   G.     A signed Consent Form may only be revoked in writing. The revocation must be signed by
          the student and the parent/guardian prior to testing. A student who withdraws will no longer
          be subject to random drug testing and will not be eligible for participation in the voluntary
          activities or privileges covered by this policy until after the end of the current school year.
          After the current year ends, students who desire to participate in any of the voluntary
          activities must agree to participate in the random student drug testing program by submitting
          a new consent form.

   H.     A percentage of the students subject to testing at each high school shall be selected for
          random testing on a periodic basis as deemed appropriate by the Superintendent.

   I.     Refusal to submit to random testing when selected will be treated as a positive test, which
          invokes the appropriate consequence outlined in this policy.

   J.     Except for the students subject to testing per parent request as set forth in Section (C) above,
          no student may be randomly tested more than three times in any academic year, so long as
          the test results are negative.

   K.     The Superintendent may choose not to include certain groups in the testing pool or choose to
          suspend testing altogether if there are insufficient funds to perform the tests.

III. Consequences of testing

   The student shall not be subject to suspension from school for a positive test, unless the student is in
   violation of other portions of the Avery County Schools' Student Code of Conduct.

   Students will not be penalized academically for testing positive for illegal drugs or banned
   substances under this policy.

   Many students participate in several voluntary activities, and may participate in multiple activities
   at one time, such as participating in a sport as well as obtaining a parking privilege. The
   consequences for a positive test will apply to all activities the student is currently participating and
   may apply to participation in future voluntary activities as well.


   A. First Offense: The principal will suspend the student from the interscholastic athletic contests for
      30 school days or two (2) athletic contests, whichever is greater, from the date when the written
      findings are provided to the principal. In addition, the student must successfully complete the
      following:
          1. Student meets with the school counselor within the first full week of suspension or upon
              return to school.
          2. Student undertakes a substance abuse evaluation by a licensed addiction specialist. If the
              licensed addiction specialist recommends interventions or treatment, student must have
              begun the process of receiving the interventions or treatments. Avery County Schools is not

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            responsible for the cost of the prescribed interventions or treatments; however, the student is
            eligible to enroll in the Avery Student Assistance Program at no charge.
 B. Second Offense: The principal will suspend the student from all athletic activities for a period of
    360 school days from the date when the written findings are provided to the principal.
 C. Third Offense: The principal will suspend the student from all athletic activities for the remainder
    of his/her high school career in the Avery County Schools.

V. Implementation

 A.     Key Implementation Roles

        1. Contracted Test Administrator (Vendor) – The drug testing program will be
           implemented on behalf of the school district by a Test Administrator, which shall be an
           independent agency or entity operating under contract with the Board of Education. The
           contracted Test Administrator shall have experience in implementing a drug testing
           program.
        2. Medical Review Officer (MRO) – The contracted Test Administrator shall employ or
           provide by subcontract, a licensed physician certified as a Medical Review Officer.
        3. Superintendent's Designee – The Superintendent shall designate an administrator of the
           school district to coordinate the district's drug testing program (District Drug Test
           Coordinator). This administrator will receive all information and results provided by the
           vendor and the MRO in order to fully coordinate this program.
        4. Licensed Substance Abuse Professional (LSAP) – Licensed substance abuse
           professionals whose professional credentials are acceptable to the Superintendent and/or
           designee shall conduct all substance abuse assessment and counseling services.

 B.     Role of School System Employees – Avery County School personnel shall not assist with
        the actual testing or physical collection of the samples, shall have no access to the test
        samples, and shall not select the students who will be randomly tested. These functions will
        be carried out by the contracted Test Administrator. School system employees will be
        expected to call students from their regular class schedule and assist with coordinating
        testing as needed.

 C.     Process to Select Students to be Tested – Eligible students will be randomly selected for
        testing by the contracted Test Administrator using the following process:
        1. The Superintendent’s designee shall maintain a list of all eligible students who have
            signed Consent Forms. The list shall be updated prior to each testing date.
        2. Each eligible student on the list shall be assigned a number by the Superintendent’s
            designee.
        3. The Superintendent’s designee shall provide the contracted Test Administrator with a list
            of the students’ numbers.
        4. Prior to each testing date, the Superintendent’s designee will notify the contracted Test
            Administrator as to what percentage of students will be tested.
        5. The contracted Test Administrator shall randomly generate a list of student numbers
            representing students to be tested. The randomly generated student numbers shall be
            categorized by school, and to the extent practicable, shall consist of the same percentage
            of students at each school. Students who were absent on a testing date, after their

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             previous selection under this random selection process, shall be added to the next
             randomly generated list. The list shall be provided to the Superintendent’s designee.
          6. The Superintendent’s designee will match the randomly generated student numbers with
             the students’ names, and will notify each school, which students are to be tested using
             RDT Form 2A.
          7. Documentation of the selection process shall be maintained.

   D.     Absences – A student who is absent on the day of a test shall be excused from testing, but
          shall be added to the pool to be tested on the next testing date. However, a student who is
          present at school on the day of testing and avoids testing by leaving campus (or cutting
          class) without a valid excuse for that day shall be considered as having refused to be tested.

   E.     Refusal to Test or Tampering with a Test – A refusal to be tested, or an attempt to alter,
          substitute, adulterate or otherwise tamper with a test sample, shall result in a declaration of a
          positive test which invokes the appropriate consequence outlined in this policy.

   F.     Frequency of Tests – Random drug testing will be conducted as frequently as possible
          during the academic year. The dates and times of testing will not be publicized in advance.

   G.     Location of Tests – To the extent possible, the testing will occur at the school which the
          student attends.

   H.     Number of Students Tested – The percentage and/or number of eligible students at the
          high school which will be tested in the course of a year will be determined by the
          Superintendent or designee. The Superintendent or designee shall determine what number
          and/or percentage of eligible students are tested on each test date as stated in RDT Form 2A.

   I.     Type of Tests – Testing will be by urine or saliva specimen.

   J.     Confidentiality – All test results will be strictly confidential, including the maintenance of
          the sample throughout the collection and testing process. All reported results will be
          maintained by the Superintendent’s designee in a locked file cabinet. Disclosure of test
          results will be limited to those who have a need to know in order to implement this policy.
          When under this policy a student becomes ineligible to participate in any voluntary activity,
          the principal shall inform the particular coach that the student is ineligible.

   K.     Falsification of Information – Students who falsify information on the required forms will
          be subject to discipline sanctions under Board Policy and the school’s Code of Conduct.

   L.     Parent Notification – Parents will be notified by school officials of their child’s
          participation in drug testing after the test is administered through RDT Form 4.

VI. Tested Substances The student will be tested for substances recommended by the contracted Test Administrator and as determined by the Superintendent or designee.

VII. Substance Abuse Assessment/Counseling Requirement

   Whenever a student is required to satisfy the substance abuse assessment/counseling requirement of
   this policy, the student shall:
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  A.    Undergo a substance abuse assessment by a licensed substance abuse professional. At
        parents' request a list of licensed professionals will be provided. This assessment shall be at
        the expense of the parent/guardian.

  B.    Provide the school principal with written certification by the licensed substance abuse
        professional that the substance abuse assessment has been completed.

  C.    Undergo counseling/treatment or other intervention, if any, as recommended by the licensed
        substance abuse professional. The Board of Education will not specify requirements of any
        such counseling/treatment or intervention, as this will be based on the student’s individual
        needs. The Board of Education’s interest is that the student receives whatever assistance is
        appropriate for the particular individual.

  D.    Failure to fully cooperate or comply with substance abuse assessment or any
        counseling/treatment program recommended by the licensed substance abuse professional
        shall make the student ineligible for participation in the voluntary activities covered by this
        policy.

VIII. Test Procedures and Safeguards A. Urine Test – Testing will be by urine specimen. If the student is physically unable to provide a urine sample, a saliva test may be administered.

  B.    Screening Test – The urine specimen shall be screened using an enzyme immunoassay
        (EIA) test or other screening test approved by the College of American Pathologists (CAP)
        or the Department of Health and Human Services (HHS).

  C.    Confirming Test – If the screening test indicates the presence of a controlled substance, the
        specimen shall be subject to a confirming test by gas chromatography/mass spectrometer
        (GC/MS).

  D.    Split Sample – Each student’s urine sample shall be split into two samples. In the event of
        a confirmed positive test, a student may request that a portion of his/her urine sample be
        tested by another state or federal approved laboratory at his/her expense. If this test result is
        negative, the student/parent will be reimbursed.

  E.    Standards for Positive Test – The contracted Test Administrator will use the standard
        cutoff scores generally used by CAP or HHS for determining a positive test result.

  F.    Use of Licensed Laboratory – The contracted Test Administrator must use a laboratory
        that is appropriately licensed by CAP or HHS. (The laboratory must also be approved by
        North Carolina state law and accredited to conduct drug testing in this state.)

  G.    Use of Certified MRO – The contracted Test Administrator must use a physician who is a
        certified MRO who has met the federal regulation requiring initial MRO certification.
        Current MRO re-certification must be maintained either through the Medical Review Officer
        Certification Council (MROCC) or through the American Association of Medical Review
        Officers (AAMRO).


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  H.     Expense - The expense, if any, of the assessment or counseling/treatment program shall be
         the responsibility of the parent/guardian, not the Avery County Schools.

IX. Medical Review Officer A. The Test Administrator shall report any test found "positive" for the presence of a tested substance directly to the MRO.

  B.     The MRO shall notify the student and the student’s parent/guardian of the test results and
         provide an opportunity to present information, such as the documented use of a prescription
         medication or an over-the-counter drug, which would render an apparent "positive" result
         invalid or "negative."

  C.     Failure or refusal of the student or the student’s parent/guardian to cooperate with the MRO
         shall constitute a refusal to test, which is considered a positive test.

  D.     The MRO shall inform the student and the student’s parent/guardian of the opportunity for
         an additional confirming test at the student’s/parent’s expense on the remaining sample of
         the student’s urine. If the additional confirming test is negative, the student/parent will be
         reimbursed.

  E.     If the MRO determines that an apparent "positive" test result is the result of a lawful use of a
         prescription or non-prescription drug, the test result shall be considered as "negative."

  F.     If the MRO determines that the test results are valid and positive, the MRO shall inform the
         student, the student’s parent/guardian of this determination, and the Superintendent's
         designee.

X. Receipt of the Test Results

  The results of the random drug/alcohol tests will be sent to the Superintendent's designee. The
  Superintendent or designee will deliver test results to the principal. The parent/ guardian of the
  student tested will be informed of the test results. In the event of a positive test, a parent conference
  should be scheduled immediately to review the results of the positive test. At the parent's and/or
  student's request, the conference may be attended by the adult/school employee supervising the
  voluntary activity. In the event that the parent/guardian questions the accuracy of the positive test, a
  student may request that a portion of his/her urine sample be tested by another state or federal
  approved laboratory at his/her expense. If this test result is negative, the student/parent will be
  reimbursed. The Superintendent reserves the right to make a final decision on eligibility. A student
  who tests positive for illegal and/or controlled substances becomes ineligible for the voluntary
  activities as defined in this policy. Ineligibility will include partici-pation, practice, dressing out, or
  appearing with the team or group in any way. Any student who tests positive for drugs/alcohol, in
  addition to other penalties listed in this policy, will provide a negative drug test in order to become
  eligible.

X. Method of Collection of Urine Samples

  The following procedures shall be used for the collection of urine specimens at the individual
  schools.


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A. Notice of Collection – The principal or designee will notify students to report to a designated area. When the student(s) arrives at the designated area, he/she will be notified of the drug testing procedure and isolated from students not being tested. Student(s) will complete an information sheet outlining current use of prescription and over-the-counter medications and vitamin supplements using Form RDT Form 3.

B. Cooperation – If the student refuses to cooperate with school employees or the contracted Test Administrator’s staff, the student’s refusal to cooperate shall be treated as a "positive" test result.

C. Time of Collection – In general, urine specimens will be collected as determined by the contracted Test Administrator in conjunction with a school administrator.

D. Collection, Location, Supplies and Equipment – Each school and the contracted Test Administrator shall select by mutual agreement one or two restrooms to use for collecting urine samples.

E. Protection of Student’s Privacy – The contracted Test Administrator’s staff shall not view a student in the act of providing a specimen, but shall monitor each student in a non- intrusive but controlled manner to detect any attempt to provide a false urine specimen. Immediately upon receipt of a urine specimen it shall be tested to determine its temperature. All specimens outside of normal temperature limits will be considered invalid and the student shall be required to provide another urine sample.

F. Chain of Custody – The contracted Test Administrator shall implement procedures to ensure that each student’s urine sample is appropriately labeled and secured to prevent each sample from being lost, misplaced, or contaminated. At a minimum, the contracted Test Administrator shall:

 1. Provide each student with a sanitized kit containing a specimen bottle. The bottle will
    remain in the student’s possession until a seal is placed on the bottle by the collection
    staff. The student will sign a form certifying that the bottle contains his/her urine sample
    and that the specimen has been sealed. The seal may be broken only by the lab testing
    the specimen.
 2. After the specimen has been sealed, the specimen shall be transmitted to the testing
    laboratory by the contracted Test Administrator.
 3. In order to maintain confidentiality, the specimen bottle shall be labeled with the
    student’s number and not the student’s name. In addition, the results sheet mailed by the
    laboratory to the contracted Test Administrator or MRO shall report the results by
    student number and not by name.

G. Refusal or Inability to Provide Sample – The contracted Test Administrator shall implement appropriate procedures for use in the event a student refuses to provide a urine sample or states that he/she is physically unable to provide a urine sample. A refusal to provide a urine sample will be treated as a "positive" test result with consequences stated in Section VII of this policy. If a student says that he/she is unable to provide a urine specimen, the student will be given water to provide a urine sample. If the student is still not able to provide the urine sample a saliva test will be administered. If the student states that he/she has a medical problem that prevents the student from providing a urine sample, the student will be given the opportunity to communicate with the MRO, who shall 8 determine whether or not the student has a legitimate medical reason not to be tested by a urine specimen and will, in turn approve a saliva test.

XI. Evaluation and Review of Policy The contracted Test Administrator shall provide periodic statistical reports (without identifying student names) to the Superintendent’s designee, indicating the numbers of students tested and the numbers of first, second and third positive test results, by substance and by school. The Superintendent will make an annual report to the Board of Education regarding the impact of this policy. Two years after the policy's adoption, the Board will review the policy's effectiveness and vote whether to maintain, revise or cancel the policy.

Legal References: U.S. Const., Amend. IV; N.C. Gen. Stat. 115C-47(4); Bd. Of Education of Independent School Dist. No. 92 of Pottawatomie County v. Earls, 122 S. Ct. 2559 (2002)

Adopted: 7/10/12

Revised:

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AVERY COUNTY SCHOOLS

STUDENT ATHLETE, CHEERLEADER, STUDENT DRIVER, EXTRA-CURRICULUAR PARTICIPANT AND PARENT PERMISSION AND CONSENT FOR RANDOM DRUG AND ALCOHOL TESTING

Student’s Consent

Student’s Name (Please print.) Date

I have read and understand the Avery County School System’s Random Drug and Alcohol testing procedures. My signature verifies that I will consent to random drug/alcohol testing while I am involved in athletics, cheerleading, or during any time in which I register, operate or park on Avery County School campus. This consent is good for this school year only. Failure to return this form will result in loss of driving privileges and/or participation in athletics and/or cheerleading.

Student’s Signature Date

Parent’s Permission

I have read and understand the Avery County School System’s Random Drug and Alcohol testing procedures and give permission for my son/daughter to participate in the random drug/alcohol testing program at any time during this school year when he/she is involved in athletics, cheerleading, or when he/she is registering, operating or parking a motor vehicle on Avery County School campus. Failure to return this form will result in loss of driving privileges and/or athletic eligibility of my child.

Parent/Legal Guardian’s Signature Date

                                                                                     RDT FORM 1




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MEMORANDUM

TO: Dr. Todd Griffin, Principal

FROM: David Burleson, Superintendent, Avery County Schools Athletic Director, Avery County Schools

DATE: (Insert Date)

RE: Notification of Random Drug Testing for Extra-curricular Participants, Student Drivers, Cheerleaders, and Athletes

This memo is to notify you that _____ is the designated day for the random drug testing of student drivers, cheerleaders, and athletes. You will be provided the list of names of students selected to be tested by 7 a.m. on the test date through e-mail. Please ready the testing site, parent notification letters, student questionnaires, and urine collection cups for the testing. This information should be kept in the strictest confidence.

                                                                                  RDT FORM 2



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MEMORANDUM

TO: Dr. Todd Griffin, Principal

FROM: David Burleson, Superintendent, Avery County Schools Athletic Director, Avery County Schools

DATE: (Insert Date)

RE: Students Selected for Random Drug Testing

Attached is a list of student identification numbers which have been randomly selected for drug testing. The testing will be done on _____ (date). Students must be called as listed, excluding a student only if absent, away from campus, involved in testing, etc. Your school should test ____ (number) students today.

Testing personnel should arrive at your school between 8:00 and 8:15 a.m., and the testing should begin about 8:30 a.m. Please see that all parent-notification letters, student questionnaires, and urine collection cups are ready at the testing site.

If you need assistance before or during the testing, please call David Burleson at 733-6006 or 260-5517.

                                                                                      RDT Form 2A




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MEMORANDUM

TO: Dr. Todd Griffin, Principal

FROM: David Burleson, Superintendent Athletic Director

DATE: (Insert Date)

RE: Follow-up of Random Drug Testing of Student Drivers, Cheerleaders, Extra-curricular Participants and Athletes

Thank you for your cooperation in the random drug testing of student drivers and athletes conducted today. Everything seemed to go very well, and I appreciate your staff’s care to follow the procedures.

Please forward to me a copy of the student sign-in sheet, the chain of custody forms, and a copy of the e-mailed list of names I sent to you for testing. Beside the name of any student who was not tested, please indicate the reason.

I will notify you of the results of the testing as soon as I receive them from the lab.

If you have concerns or suggestions for improving the testing, please share them with me at your earliest convenience.

Again, thank you for a job well done.

                                                                          RDT FORM 2B




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                                AVERY COUNTY SCHOOLS
                          STUDENT INFORMATION SHEET
                        Random Drug and Alcohol Testing Program
  1. Student Name Student Id # _ ____

  2. Address Phone #

  3. Parent/Guardian Name(s)

  4. Birthdate Social Security Number

  5. High School

  6. Check all that applies Participant in athletics this season ______ Extra-Curricular Participant Cheerleader Student Driver License #

  7. List any prescription medication currently taking and time of last dose

  8. List any over-the-counter medication currently taking and time of last dose (include vitamins and herbal supplements)

  9. Describe any other circumstances that may cause your test for alcohol and drugs to register positive.

I certify that the information provided above is truthful to the best of my knowledge. I am aware that I have been selected for random drug and alcohol testing and agree to the testing procedure.

Student’s Signature Date

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                             RDT FORM 3

……………………………………………………………………………………………………… ………………………………… For Office Use Only

The above student, ________, was not tested due to:

___ Absence from school ____Enrolled in class off campus

___Mandatory academic testing ____Other (please list)

___Refused to be tested

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(Print on School Letterhead)

(Insert Date)

Dear Parent/Guardian:

Re: _____

Today, your child was randomly selected for drug/alcohol testing, using the guidelines established by the Avery County Board of Education. As you are aware, notification of this procedure was provided to you, and your consent for testing was granted through your signature on the proper forms.

Test results should be available within five days. When test results are available, you will receive a letter explaining these results. If the test indicates the presence of a controlled and/or illegal substance, we will contact you and arrange for a conference. At this conference, the test results will be explained and procedures for appeal and the availability of drug treatment will be discussed. You and your child will be asked to sign a statement that you attended the conference. Upon notification to the school system of positive test results, your child is immediately ineligible to participate in athletics, cheerleading, or to register, operate or park a motor vehicle on any Avery County School campus.

Thank you for your support of the Avery County Schools’ Safe and Drug Free Programs. Please feel free to contact me if you have questions or concerns.

Sincerely,

Dr. Todd Griffin Principal

RDT FORM 4

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(Print on school letterhead)

(Insert Date)

Dear Parent/Guardian:

Re: ______

The purpose of this letter is to inform you that your child’s random drug/alcohol test was negative, indicating no presence of illegal and/or controlled substances.

Please remember that as long as your child participates in athletics, cheerleading, or registers, operates, or parks a motor vehicle on campus, he/she remains eligible for random drug and alcohol testing.

A copy of your child’s results is available for your review upon request.

Thank you for your continued support of our Safe and Drug Free Schools policies.

Sincerely,

Dr. Todd Griffin Principal

                                                                                     RDT

Form 5

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(Print on school letterhead)

Date

Dear ______,

Re: _______

The purpose of this letter is to notify you that your child’s random drug/alcohol test was positive, indicating a presence of illegal and/or controlled substance. We have attached a copy of the results for your review. I would like to meet with you at your earliest convenience to discuss the consequences of the positive test.

A student who tests positive becomes ineligible to participate in athletics or cheerleading or to operate a motor vehicle on a Avery County School campus for 365 days unless he/she successfully completes the approved drug/alcohol treatment program. Upon successful completion, the student may be eligible to resume athletics, cheerleading or registering, operating, or parking a motor vehicle after 30 days or after the end of the sports season, whichever comes later.

Due to the positive drug test results, if reasonable suspicion exists, the school principal or designee may require the student to be tested for illegal and/or controlled substances.

If you feel that the test results are in error, a second test may be given by a testing laboratory approved by the Avery County Board of Education within 24 hours of receipt of this letter. The Superintendent or designee reserves the right to make a final determination of eligibility.

Please call me to arrange a time to discuss these issues.

Thank you.

Sincerely,

Dr. Todd Griffin Principal

                                                                                RDT Form 6



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   This is to certify that a conference was held on ___________________________ at
                                                               Date

   ______________ o’clock at ___________________________ to discuss the positive
       Time                          Location

   drug/alcohol test results of _________________________________. In attendance
                                         Student’s Name

   were ______________________________, _______________________________

   __________________________________, _______________________________

   __________________________________, _______________________________.

The following information was discussed:

• a review of your child’s random drug/alcohol test results

• procedures to submit documentation of any medication being taken

• the opportunity to submit a portion of the student’s urine sample to a private approved laboratory at the parent/guardian’s expense

• the penalties associated with testing positive for drug or alcohol use

• enrollment in? Program or other comparable program as approved by the Superintendent.

Our signatures certify that we attended the conference concerning the positive test results of the random drug and alcohol screening and the above items were discussed.

   _________________________________                     ______________________________
         Parent Signature                                        Parent Signature

   _________________________________                     ______________________________
         Student Signature                                  Principal/Designee Signature

   _________________________________                     ______________________________
     Other Signature     Position                           Other Signature Position




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