STUDENTS
09.423AP
ADAIR COUNTY SCHOOLS
STUDENT RANDOM DRUG TESTING PROGRAM PROCEDURES
RANDOM DRUG-TESTING PROGRAM
Statement of Purpose/Need - In today’s society alcohol and other forms of drug abuse are widespread. School settings are not
exempt from this phenomenon. Due to the seriousness of illegal drug use and in order to safeguard the health and well-being of
students, it is critical that educators and parents continually look for ways to institute programs that encourage a drug-free
lifestyle. It is to that end that the Adair County Board of Education has adopted a mandatory random student drug testing
program, created to provide an action plan to address and foster a drug-free environment through education, prevention and
intervention.
Program Participants - The Adair District Random Drug Testing Program is mandatory for students in grades 6 through 12
participating in middle/high school competitive extracurricular activities, athletics, cheerleading, school organizations/clubs,
(including but not limited to academic teams, FFA, FBLA, FEA, FCCLA, HOSA, Beta, NHS, VICA and STLP) and students
who drive or park on school property. In addition to the random mandatory drug testing program, parents of students in grades 7
through 12 are provided the opportunity to enroll their child(ren) in a voluntary random drug-testing program.
Program Goals (education, prevention and intervention) – The Random Drug Testing Program supports the comprehensive
educational policies and programs of the District in educating students and their parents/guardians of the dangers of drug abuse.
The Program is extensive in that it encompasses education, prevention and intervention as a means to deter and overcome drug
abuse. The program is not academically punitive, it is designed to create safe, drug free school environments and offer assistance
when needed. Drug testing and drug education is a student deterrent to initiating drug use, providing identification and the
opportunity for early intervention for students who have just started experimenting with drugs and intensive intervention for
students with more serious drug abuse/addiction. Identification is the first step in referring students and families to appropriate
treatment options.
Random drug testing also helps students standup to peer pressure and avoid drug use, so they can participate in their favorite
school activities. Overall the program presents a united effort in deterring drug use and setting a standard for all students that
will enhance their health, safety, education and future success.
Non-Punitive Nature of Program – Any violation by a student shall be reported to the student’s parents or legal
guardians (if student is under age 18). No student shall be penalized academically for testing positive for illegal drugs or
banned substances during random drug testing. The results of random drug tests shall not be documented in any student's
academic records or used for any other disciplinary purposes other than those set forth herein. The sole purposes of the voluntary
random drug testing program is to act as a deterrent to student drug use and to offer intervention to students testing positive for
drug use.
Program Orientation/Information - Information about the Drug Testing Program will be made available in the Student Code of
Conduct Handbook, on the District Web Site and at the time of individual or group program enrollment.
Program Implementation Process - At the beginning of each school year, and at the start of middle school/high school athletic
or cheerleading season or club/organization activities, before tryouts or any program activities, the head coach/sponsor shall
provide a random drug testing and drug awareness informational meeting with parents/guardians and students wishing to
participate in the activity.
The Principal or designee (assistant principal or school counselor) will provide random drug testing and drug awareness
information to parent/guardians and students interested in enrolling in the voluntary testing program and students who drive or
park on school property.
All required paperwork and requirements of the Random Drug Testing Program shall be completed before a student is
considered as a volunteer member, campus driver/parker or participates in competitive extracurricular activity tryouts, practice
or program activities.
Program Intervention – District and school staff will work with parents/guardians and students to provide counseling and
resources to help identified students overcome drug abuse. Drug abuse counseling services are available at each school through
the Adanta School Program.
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Program Implementation - A Substance Abuse Prevention Committee (District Drug Testing Coordinator/Assistant
Coordinator, high school/middle school principals, assistant principals, counselors, athletic director, club/organization sponsors
and head coaches) shall have the overall responsibility for implementing the student random drug-testing policy/procedures.
Annually or as need arises, the Committee shall review and update procedures to implement the program fairly and efficiently
and shall evaluate the program’s overall effectiveness.
Program Evaluation - The program evaluation shall include, but is not limited to, the effectiveness of the comprehensive
educational and counseling program, substance testing program, procedural safeguards, and the list of drug substances tested.
School personnel may collect anonymous survey data. Results are to be used for the sole purpose of determining program
success as related to student, parent, and teacher attitudes toward drug use and the testing program. Surveys conducted for the
evaluation of the program are voluntary. Students will not be penalized for not participating in the surveys.
Test Results Access - The Program committee and all other school personnel shall only have access to student testing results, if
directly involved with the student, as parent/guardian (of student under the age of 18), superintendent, principal, assistant
principal, school counselor, activity sponsor/coach, athletic director, district/assistant drug testing coordinator or outside
agency(s) agreed upon by parent/guardian as part of student treatment/evaluation, or others designated by the Superintendent on
a need-to-know basis.
District Program Oversight - The designated District Drug Testing Coordinator (DDTC) and Assistant Coordinator will act as
the primary points of contact between the drug testing company and the school district in implementing and providing oversight
of the program. The DDTC or assistant will provide the drug testing company with a list of students that are to be entered into
the testing pool. The DDTC or Assistant Coordinator will update this list three (3) school days prior to each testing date.
School Program Oversight/Implementation – The middle and high school principals are directly responsible for program
implementation oversight at the school level. The middle and high school assistant principals in collaboration with the
counselor(s), athletic director, team coaches, clubs/organizations sponsors shall implement the requirements of the Random
Drug Testing Program. These responsible parties shall ensure that prior to any students in grades 6 through 12 (current or future
enrollees) participating in middle/high school extracurricular competitive athletics, cheerleading, band, clubs/organizations,
tryouts, activities, practice, competitions, volunteer drug testing, parking or driving on campus the student and parent/guardian
shall be provided a written copy of the Random Drug Testing District Policy and Procedure 09.432 and the student and
parent/guardian must acknowledge in writing on the designated forms, that they have read the random drug testing policy and
procedure, understand the policy and procedures, and agree to be bound by the terms and conditions.
Coaches/Sponsors of Random Drug Testing Activities – Coaches/sponsors of activities covered by the Random Drug Testing
Program are responsible for implementing the Program requirements. Within three (3) school days following student tryouts or
enrollment in any competitive extracurricular athletic, cheerleading or organization/club, the activity coach/sponsor shall
establish and make available a roster of all program participants and copies of all required parent and student random drug
testing paperwork to the Assistant Principal, who will ensure all paperwork is complete and file copies of required paperwork in
a locked file cabinet in his/her office.
Throughout the school year, coaches/sponsors are responsible for reporting to the Assistant Principal in writing within three (3)
school days any changes to the activity enrollee roster (additions/withdrawals). Each athletic/cheerleading coach/sponsor shall
maintain an ongoing up-to-date roster of student participants. Required paperwork and rosters for student drivers and parkers
will also be maintained by the Assistant Principal.
The school counselors shall provide school oversight/implementation of the middle/high school’s voluntary Random Drug
Testing Program and rosters for students in grades 7-12. The counselors shall ensure all paperwork is complete for each
voluntary participant enrolled and file program paperwork in a locked file cabinet in his/her office. The school counselor shall
maintain a current roster of all student volunteers participating in the program. Within (3) three school days following student
voluntary drug testing enrollment, a roster is to be presented to the District Drug Testing Coordinator. Any changes
(additions/withdrawals) in the voluntary drug testing enrollment during the school year are to be reported in writing by the
counselor to the District Drug Testing Coordinator within three (3) school days.
At the end of each school year when middle school students advance to the high school, the middle school assistant principal and
counselor will send student drug testing participant paperwork to the high school assistant principal and volunteer participants to
the high school counselor(s), who will add the students to the high school drug testing roster.
Staff Training -The high school and middle school assistant principals and counselor(s) will provide Program training for staff.
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Drug Testing Records - One (1) year after the student turns eighteen (18) years of age or one (1) year after the student
graduates, whichever is later, all records in regard to this procedure concerning each student shall be destroyed, and at no time
shall drug testing results or records be placed in the student’s academic file or be voluntarily turned over to any law enforcement
agency, or used for any purpose other than those stated herein. For students who transfer into the District or otherwise do not
fulfill the requirements for graduation, the records of that student shall be destroyed one (1) year after the student turns eighteen
(18) years old.
Confidentiality - Appropriate measures shall be taken to protect student confidentiality throughout the testing process and in
the handling of test results. Staff shall maintain confidentiality of all student drug-testing records in accordance with the written
school policy and Family Education Rights and Privacy Act. School personnel are bound to keep all information in the strictest
of confidence and are to release information only to others as dictated by Board policy or properly obtained permission of the
student’s parent/guardian or student if age 18 or older. The results will not be shared with law enforcement officials, including
school resource officers, other school districts, criminal or juvenile authorities or the court system unless by valid and binding
subpoena or other legal process, not solicited by the District.
RANDOM DRUG TESTING PROGRAM PROTOCOLS
1. Program Enrollment - At the beginning of each school year and throughout the school year, students in grades 6-12
prior to joining or participating in middle/high school extracurricular competitive activities, athletics, cheerleading,
organizations/clubs (including but not limited to academic teams, FFA, FBLA, FEA, FCCLA, HOSA,
Beta, NHS, VICA and STLP), driving or parking on school property or prior to students in grades 7-12
enrolling in the volunteer program, the student and parent/guardian must read the Adair County School District
Random Drug Testing Policies/Procedures 09.432 and acknowledge in writing on the designated form, that they have
read, understand and agree to abide by terms and conditions of the policy/procedures. The parent/student must also
sign, the “Student and Parent/Guardian Consent to Perform Urinalysis for Drug Testing Form” and “Release of
Student Drug Counseling Information Form”, allowing school staff to verify student drug counseling requirements is
being met following a positive drug test.
Prior to providing a urine specimen, each student participant shall complete a “Consent to Test and Chain of Custody
Form”.
Volunteer Program Enrollment - Parent/guardians and students may gain information and fill out the necessary
paperwork for the voluntary program at the yearly orientation meeting or by meeting with a school counselor, who will
review program guidelines and provide required paperwork for participation.
Students are only required to enroll once in the Random Drug Testing Program to be eligible to participate in competitive
extracurricular activities or to drive or park on campus. However, volunteer enrollees are only eligible to participate in
the volunteer program. Volunteer participants who wish to join a middle/high school competitive extracurricular
activity, athletics, cheerleading, clubs/organizations or drive or park on school campus must complete the
mandated random drug testing forms required for these activities.
2.
3.
Once a student enrolls in the Random Drug Testing Program, they shall remain in the Program testing pool for the
duration of their enrollment in the Adair County School District, unless the parent officially completes a
Drug/Alcohol Testing Program Withdrawal Form available in the assistant principal’s office or the student becomes
ineligible through Program guidelines. During enrollment students remain eligible for drug testing, whether or not they
have been tested previously or are currently participating in programs/activities covered by the Program. Withdrawal is
a student/parent decision and is not to be initiated by school staff.
A break in enrollment in the Adair County School District for 21 or more consecutive school days will require new
Program enrollment paperwork to be completed by the student/parent.
Parents/guardians are encouraged to allow their student(s) to remain in the testing pool, throughout school enrollment
however, they do have the option to withdraw their child from the Random Drug Testing Program by completing a
Random Drug and Alcohol Testing Withdrawal form in the school assistant principal’s office.
Withdrawal from the Random Drug Testing Program will immediately suspend the student from participation in all
activities covered by this Program for six (6) months, however the student has fifteen (15) calendar days to reconsider
his/her withdrawal decision and reenter the random drug testing pool. Eligibility to continue in the previously enrolled
activities will be the decision of the coach/sponsor.
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4.
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7.
The collection of urine specimens and the scientific analysis of the collected specimens will be conducted by a
professional testing company contracted by the Board.
The testing company approved by the Board shall randomly select students to be tested from all identified Program
enrollees by utilizing a computer-based system that is designed specifically for randomly selecting individuals for drug
testing. The students to be tested and drug test dates are unannounced.
A 10 panel + expanded opiate drug test is used. Random drug testing will include, but is not limited to the
following: alcohol, marijuana (THC), amphetamines, cocaine, phencyclidine (PCP), barbiturates,
benzodiazepines, propoxyphene, methaqualone, methadone and the expanded opiates which include codeine,
morphine, hydrocodone, hydromorphone, oxycodone, 6mam and other controlled substances.
Collection procedures for urine specimens have been developed and will be administered by the testing company in
collaboration with school personnel. In an effort to minimize any intrusion or embarrassment of tested students, ensure
the proper identification of students’ specimens, minimize the likelihood of the adulteration of a urine specimen and
maintain confidentiality of test results. Collection procedures are as follows:
a. The collection of urine specimens shall be conducted on school premises. The testing laboratory personnel and
school personnel designated by the principal will work cooperatively during the testing process. School
personnel will escort randomly selected students from the classroom to the collection site, identify the student
and provide supervision at the collection site (usually restrooms in the boys/girls locker rooms are utilized for
testing - providing separate male and female testing sites). Students will be given instructions at the time of the
random drug testing specimen process.
Immediately prior to giving a urine specimen, each student shall complete all forms required by the testing
company.
b. Before entering the private restroom facility utilized for the collection process, the student shall be required to
leave all personal belongings (including jackets, purses, book bags, pocket contents, etc.) in the custody of the
school representatives, present for student identification. The drug testing company will prepare the collection
site and will conduct pre and post inspection of the site. The student will be presented a receptacle for
collection of urine and will enter an individual restroom stall providing absolute privacy during the collection
process. Once the specimen is presented to the collector, both the student and the collector must maintain visual
contact with the specimen until the bottle(s) are sealed and labeled.
c. Refusal by a student to be tested shall be treated as a violation and the appropriate consequences will be
assessed (see consequences). The parents/guardians shall be notified by the Principal of the refusal and
consequences.
Continued refusal of the student or parent/guardian to submit and cooperate fully in the Drug Testing Program
shall render the student ineligible to participate in the District programs covered by the Random Drug Testing
Policy/Procedures, until such time as the student and/or his/her parent/guardian fully submits and cooperates
with the Drug Testing Program and meets the reinstatement requirements of the activity coach/sponsor.
d.
All positive urine specimens go through two different drug testing types. The first is the highly accurate
immuno assay (“EMIT”) screening test and if this test shows a non-negative (positive), then the specimen
is sent for a second confirmation test called Gas chromatography Mass Spectrometry GC/MS. Only after
the GC/MS confirmation shall a test result be reported as positive. If a test result has been adulterated, the
student may be required to be retested. All non-negative (positive) specimens are held at the lab for (12)
twelve months.
e. Medical Review Officer - The testing laboratory Medial Review Officer (MRO) will review all results of the
urine drug-testing program. A positive test for illicit or banned substances will be handled according to lab
guidelines. Depending on the substances found in the urine, the MRO will contact the parent/guardian
(student, if age 18 or over) to determine, if the student is on any prescribed medication from a physician that
may have caused the positive result. Failure by the student and parent/guardian to produce the verifying
information will result in a positive test result. If the MRO determines that there is a legitimate medical
explanation for the positive test other than use of a prohibited drug, the MRO will conclude that the test is
negative and will not take any further action.
If the MRO concludes that a particular test is scientifically insufficient, the MRO will conclude that the test is
negative for that student. If the MRO determines that there is no legitimate explanation for the positive test
other than use of a prohibited drug, the MRO will communicate the test results as a positive to the District
Drug Testing Coordinator (DDTC). The MRO will also communicate results of negative tests to the DDTC.
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f.
g.
h.
i.
Within 24 hours after a positive result, the Medical Review Officer (MRO), will if possible, make first
contact with the parent/guardian. The District Drug Testing Coordinator/Assistant will make the follow-up
call to the parent/guardian or student, if age 18 or older.
Written confirmation of all test results shall be forwarded by the testing company to the District Drug
Coordinator/Assistant Coordinator, who shall provide the results (negative or positive) to the
principal/designee, athletic director, head coach and club/organization sponsor. The District Drug Testing
Coordinator or Assistant shall provide parents/guardians or student (if over age 18) notification of positive
test results by written certified mail within five (5) days after receipt of written notification from the
Drug Testing Company. All test results are confidential and shall be maintained by the District Drug
Coordinator or Assistant under strict security.
The test results forwarded to the District Drug Coordinator shall indicate that positive results were
confirmed by the GC/MS technique and shall indicate the name of the individual for whom the test results
are being reported; the type of test indicated on the custody and control form; the date and location of the
test collection; the identity of the persons or entities performing the collection and analysis of the specimens
and reporting substance(s test results; the verified results of the controlled substances test; and, if positive, the
identity of the controlled) for which the test verified positive.
Test results shall be forwarded to the District Drug Coordinator in a manner to ensure that the District Drug
Coordinator cannot determine that any test was a presumptive, positive test unable to be confirmed by GC/MS.
Once a student’s urine specimen produces a positive (after the GC/MS confirmation) result and notification
is presented to the Principal, the principal/assistant principal will follow up requesting a meeting with
parents/guardians and student. The Principal/Designee, guidance counselor(s), coach/sponsor shall meet
with the student and the student’s parent(s) or legal guardian(s) (if the student is under the age of 18) to
disclose and discuss the test results. At this meeting, the Principal/Designee, shall advise the student and the
student’s parent(s) or legal guardian(s) of their procedural rights under this policy.
Parents/guardians or a student eighteen (18) years of age or older may contest a positive test result, by
presenting a written appeal to the District Drug Testing Coordinator within three (3) working days
after receipt of the written notice of a positive test result. The parents/guardians or a student eighteen
(18) years of age or older may, at the student’s expense, request an additional drug analysis. Any
additional laboratory analysis shall be conducted by the Drug Testing Company contracted by the Adair
County Board and with the student’s remaining urine specimen preserved by the Board contracted
testing laboratory.
The Superintendent/District Drug Testing Coordinator will consult with the Medical Review Officer (MRO)
and review findings of the evidence presented by the parent/guardian or student to the Drug Testing MRO
Specialist during the MRO’S initial positive test result investigation. The Superintendent will render a final
decision within five (5) working days of receiving parent/guardian or student (if age eighteen or older)
notice to contest the test results (this time line may be extended, if needed for additional drug testing
results).*The consequences of the positive test results will be enforced for all random drug testing activities during
the appeal process.
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RANDOM DRUG PROGRAM CONSEQUENCES
FOR
COMPETITIVE EXTRACURRICULAR ACTIVITIES, ATHLETES/CHEERLEADERS, CLUBS/ORGANIZATIONS
AND DRIVERS/PARKERS ON CAMPUS
Students testing positive to random drug testing shall be subject to the sanctions listed below:
1. First Violation (Positive Drug/Alcohol Test Result)
A. Notify the student’s parents/guardians or student if age 18 or older.
Following a positive drug test, the principal/designee/counselors will meet with the student and parent to
develop an on-going intervention plan.
B. Athletes, Cheerleaders, and Academic Team Members - A student testing positive shall be suspended
immediately from participation for the next four (4) consecutive interscholastic events or the next four (4)
weeks of the season, whichever is greater in time. If necessary the suspension shall carry over to the student’s
subsequent participation on another athletic team and/or the following season.
Competitive Clubs/Organizations members – A student school club/organization member (including but
not limited to the FFA, FBLA, FEA, FCCLA, HOSA, Beta, NHS, VICA and STLP) testing
positive shall be suspended from participation for the next three (3) school months from the date the
positive results are received by the assistant principal.
Drivers/Parkers on School Campus – A student driver or parker testing positive shall be suspended
from driving or parking on school campus for four (4) consecutive school weeks from the date the
positive results are received by the assistant principal.
Suspension from participation in the above mentioned competitive activities consists of any
team/club/organization activity including meetings, practicing, scrimmages, dressing out, traveling with,
or receiving recognition with or for the activity or driving or parking on campus, before reinstatement to the
team or activity.
C. Within 7 workdays days following the positive test result and before reinstatement after the first violation, the
student must complete and provide at student expense, verification of a drug assessment or evaluation
performed by a chemical dependency professional and if recommended, begin and complete a drug counseling
or treatment program. The student and his/her parent/guardian shall sign a release(s) to allow District
personnel to verify with the drug counseling/treatment program counselors that the student is following
the recommendations of the program(s).
D. Prior to readmission to participate in any activities covered under the random drug testing policy the student
shall submit and test negative to a new drug test and shall submit to regular drug testing of not less than
five (5) additional times over the next twelve (12) month period. All student drug testing will be administered
in accordance with the Board’s Random Drug Testing Policy/Procedure and conducted by the drug testing
company under contract with the Board. A positive result shall be treated as a second violation.
E. If a student is reinstated to the activity/team following the first violation, the student’s participation in
another activity covered by the Random Drug Testing Policy/Procedure shall not be restricted solely because
of the existence of the first violation, as long as the student has completed the period of suspension and has
been appropriately reinstated to the prior activity. If the student elects not to seek reinstatement to the
activity after a first violation (either because of the student’s own election or because the season concluded
prior to the expiration of the student’s period of suspension), the student is still required to serve the unexpired
portion of the suspension before becoming eligible for participation in any other random drug testing activity
and must provide a negative drug test result from the company under contract with the Board and complete
all requirements for participation.
A student serving a suspension for one activity covered under the random drug policy/procedure may try out
for a second covered activity, if the student provides a negative drug test result from the testing laboratory
under contract with the Board. If the student successfully makes the team/club/organization, prior to
participation, the student must serve the unexpired portion of the previous suspension. A positive result shall
be treated as a second violation.
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2. Second Violation
A. Notify the student’s parents/guardians or student if age 18 or older.
B. For a second violation, the student shall be suspended immediately from activities covered by the Random
Drug Testing Program for a period of one (1) calendar year from the date the Principal received the most
recent test that yielded positive results. Within 7 work days following the positive test result, the student
must begin the chemical dependency counseling program and the student must successfully complete
recommendations that resulted from the chemical dependency assessment administered following the first
violation as evidenced by a written statement to that effect issued by a qualified chemical dependency
professional.
The student program participant and his/her parent/guardian shall be required to sign a release to allow District
personnel to verify with the drug counseling/treatment program that the student is following the
recommendations of the program.
C. Prior to readmission to participate in any activities covered under the random drug testing policy the student
shall submit and test negative to a new drug test and shall submit to regular drug testing of not less than
six (6) additional times over the next twelve (12) month period. All student drug testing will be administered in
accordance with the Board’s Random Drug Testing Policy/Procedure and conducted by the drug testing
company under contract with the Board. A positive result shall be treated as a third violation.
D. If a student is reinstated to the activity following a second violation, the student’s participation in another
activity shall not be restricted solely because of the existence of the second violation, as long as the
student has completed the period of suspension and the required chemical dependency program and has
been appropriately reinstated to the prior activity. If the student elects not to seek reinstatement to an
activity after a second violation (either because of the student’s own election or because the season
concluded prior to the expiration of the student’s period of suspension), the student is still required to
serve the unexpired portion of the suspension before becoming eligible for any other athletic activity.
A student serving a suspension for one activity may try out for another activity, if the student provides
a negative drug test result from the testing laboratory under contract with the Board. If the student makes
the team/activity, prior to participation, the student must serve the unexpired portion of the previous suspension.
The student must submit to a new drug test administered in accordance with the same procedures utilized for
random drug testing. A positive result shall be treated as a third violation.
3. Third Violation
A. Notify the student’s parents/guardians or student if age 18 or older.
B. Following a third violation, the student shall be excluded from participation in any competitive
extracurricular activities, as a volunteer and driver or parker on school campus for the remainder
of the student’s enrollment in the District.
**Violations shall be cumulative throughout the student’s enrollment in all activities covered by the Random
Drug Testing Program. A positive result will suspend a student from all activities enrolled and period of
suspension time/consequences mandated by enrolled activities will be applied.
Reviewed by Board – June 17, 2010
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RANDOM DRUG TESTING PROGRAM CONSEQUENCES
FOR VOLUNTEER PARTICIPANTS
This student does not presently exercise the privilege of participating in the mandated random drug testing program required for
students enrolled in competitive extracurricular activities or driving or parking on campus, but is enrolled as a volunteer participant.
Students testing positive to random drug testing shall be subject to the sanctions listed below.
1. First Violation (Positive Drug/Alcohol Test Result)
A. Notify the student’s parents/guardians or student if age 18 or older.
Following a positive drug test, the principal/designee/counselors will meet with the student and parent to
develop an on-going intervention plan.
B. As part of the requirements for continued participation in the drug testing program after the first violation,
the student shall complete and provide at student expense, verification of a drug assessment or evaluation
performed by a chemical dependency professional and if recommended, begin and complete a drug
counseling or treatment program. The student and his/her parent/guardian shall sign a release(s) to allow the
District personnel to verify with the drug counseling/treatment program counselors that the student is following
the recommendations of the program(s).
C. Within two (2) months, the student shall submit to a new drug test administered in accordance with the
same procedures utilized for random drug testing. The testing company under contract with the Board
conducts all subsequent tests. A positive result shall be treated as a second violation.
2. Second Violation (Positive Drug/Alcohol Test Result)
A. Notify the student’s parents/guardians or student if age 18 or older.
Following a positive drug test, the principal/designee/counselors will meet with the student and parent to
develop an on-going intervention plan.
.
B. As part of the requirements for continued participation in the drug testing program, after the second violation,
the student shall complete recommendations that resulted from the required chemical dependency assessment,
as evidenced by a written statement to that affect issued by a qualified chemical dependency professional.
C. As part of the requirements for continued participation in the drug testing program after the second violation
the student must submit within two (2) months to a new drug test administered in accordance with the Board
procedures utilized for random drug testing. A positive result shall be treated as a third violation.
3. Third Violation (Positive Drug/Alcohol Test Result)
A. Notify the student’s parents/guardians or student if age 18 or older.
Following a positive drug test, the principal/designee/counselors will meet with the student and parent to
develop an on-going intervention plan.
B. Following a third violation, the student shall be suspended from the program for a period of one (1)
calendar year from the date of the most recent test that yielded positive results.
C. The student shall successfully complete recommendations that resulted from the chemical dependency
Assessment, as evidenced by a written statement to that affect issued by a qualified chemical dependency
professional.
Also, the student shall submit to regular drug testing administered in accordance with the same Board
procedures utilities for random drug testing. A positive test will be treated as a fourth violation.
4.
Fourth Violation (Positive Drug/Alcohol Test Result)
A. Notify the student’s parents/guardians or student if age 18 or older.
.
B. Following a fourth violation, the student shall be excluded from participation in the voluntary drug
testing program for the remainder of the student’s enrollment in the District.
**Violations shall be cumulative throughout the student’s enrollment in all activities covered by the Random
Drug Testing Program. A positive result will suspend a student from all activities enrolled and period of
suspension time/consequences mandated by enrolled activities will be applied.
Reviewed by Board – June 17, 2010
Page 8 of 17
STUDENTS
09.423AP
ADAIR COUNTY SCHOOL DISTRICT
RANDOM DRUG AND ALCOHOL TESTING PROGRAM CONSENT TO TEST FORM
FOR STUDENTS IN MIDDLE SCHOOL/HIGH SCHOOL GRADES 7–12
VOLUNTEER PARTICIPANT
(Complete Random Drug Testing Procedures are in the Student Code of Acceptable Behavior and Discipline Manual and on the District Website at
http://www.adair.k12.ky.us/)
Student Name: _____________________________________Current Grade: _____________________________________
(Please Print)
Student ID (enter last four digits of student’s social security number):________________School: _____________________________
This student does not presently exercise the privilege of participating in the mandated random drug testing program required for
students enrolled in competitive extracurricular activities or driving or parking on campus. However, the student and his/her
parent(s) or guardian request for the student to participate in the voluntary random drug and alcohol testing program of the
Adair County School District. The student and his/her parent/guardians acknowledge they have read and understand the Use
of Alcohol, Drugs and Other Controlled Substances Policy and Student Random Drug Testing Procedures in District’s Policy
09.423 and Procedure 09.423 AP, and agree to be bound by the terms, conditions and consequences contained in the
policy and procedures.
This student and his/her parent(s) or guardian hereby voluntarily consent to participate in the random drug and alcohol testing
program and to disclose testing results to designated District personnel and parent(s) or guardian.
This student and his/her parent(s) or guardian understand that since the student is voluntarily participating in random drug
testing, the student shall not be penalized academically for testing positive for banned substances. The privilege of this student
being allowed to participate in Volunteer Random Drug Testing Program in the Adair County School District is contingent on the
signing of this “Consent to Test Form” and the “Release of Student Counseling Information Form”.
Once a student enrolls in the Random Drug Testing Program, they shall remain in the Program testing pool for the duration of
their enrollment in the Adair County School District, unless the student/parent officially completes a Program withdrawal form
available in the assistant principal’s office or the student becomes ineligible through Program guidelines.
Withdrawal from the Random Drug Testing Program will immediately suspend the student from participation in all activities
covered by this Program for six (6) months, however the student has fifteen (15) calendar days to reconsider his/her withdrawal
decision and reenter the random drug testing pool.
A break in enrollment in the Adair County School District for 21 or more consecutive school days will require new enrollment
paperwork to be completed by the student/parent.
Volunteer Program enrollees who wish to join a middle/high school competitive extracurricular activity, athletics, cheerleading,
band, clubs/organizations or drive or park on school campus must complete the mandated random drug testing forms covering
these activities.
______________________________________________
Student Signature
______________________________________________
Parent/Guardian Name (print)
______________________________________________
Parent/Guardian Signature
______________________________________________
Home Phone
Reviewed by Board – June 17, 2010
Page 9 of 17
_________________________________________
Date
________________________________________
Work Phone
________________________________________
Date
________________________________________
Cell Phone
STUDENTS
09.423AP
ADAIR COUNTY SCHOOL DISTRICT
RANDOM DRUG AND ALCOHOL TESTING PROGRAM CONSENT TO TEST FORM
FOR STUDENTS IN GRADES 6-12 WHO PARTICIPATE IN MIDDLE SCHOOL/HIGH SCHOOL
COMPETITIVE EXTRACURRICULAR ACTIVITIES AND/OR STUDENTS WHO DRIVE OR PARK
ON SCHOOL CAMPUS
(Complete Random Drug Testing Procedures are in the Student Code of Acceptable Behavior and Discipline Manual and on the District Website at
http://www.adair.k12.ky.us/)
Student Name: ______________________________________Current Grade: ____________________________________
(Please Print)
Student ID (enter last four digits of student’s social security number):______________School: ______________________
This student and his/her parents/guardians acknowledge that the Adair County School District has the right to perform random drug and
alcohol testing on students who wish to exercise the privilege of participating in middle/high school extracurricular competitive activities,
athletics, cheerleading,, school organizations/clubs (including but not limited to academic teams, FFA, FBLA, FEA, FCCLA, HOSA,
Beta, NHS, VICA and STLP) and students who drive or park on school property.
This student and his/her parents/guardians understand that as a condition of the student being allowed to participate in extracurricular
competitive activities or driving or parking on campus in the Adair District, the student may be required to undergo and successfully pass a
random screening for alcohol, illegal drugs or other banned substances, as set forth in the District’s Use of Alcohol, Drugs, and Controlled
Substances Policy and Student Random Drug Testing Procedures (09.423 and 09.423 AP). This student and his/her parent/guardians
acknowledge they have read and understand the Use of Alcohol, Drugs and Other Controlled Substances Policy and Student Random Drug
Testing Procedures in District’s Policy 09.423, and Procedure 09.423 AP, and agree to be bound by the terms, conditions and consequences
contained in the policy and procedures.
This student and his/her parents/guardians hereby consent to participate in the random drug and alcohol-testing program and to the disclosure
of testing results to designated District personnel and parents/guardians. The student and his/her parent(s) or guardian further understand that
the student’s refusal to submit to a drug screening will be treated in the same manner as if the student had tested positive for banned
substances. No student shall be penalized academically for testing positive for banned substances during random drug testing.
The privilege of being allowed to participate in extracurricular activities in the Adair County School District is contingent on the signing of
this “Consent to Test Form” and the “Release of Student Counseling Information Form”.
Once a student enrolls in the Random Drug Testing Program, they shall remain in the Program testing pool for the duration of their
enrollment in the Adair County School District, unless the parent officially completes a Drug/Alcohol Testing Program Withdrawal Form
available in the assistant principal’s office or the student becomes ineligible through Program guidelines. During enrollment students remain
eligible for drug testing, whether or not they have been tested previously or are currently participating in programs/activities covered by the
Program.
Withdrawal from the Random Drug Testing Program will immediately suspend the student from participation in all activities covered by this
Program for six (6) months, however the student has fifteen (15) calendar days to reconsider his/her withdrawal decision and reenter the
random drug testing pool. Eligibility to continue in the previously enrolled activities will be the decision of the coach/sponsor. A break in
enrollment in the Adair County School District for 21 or more consecutive school days will require new Program enrollment paperwork to be
completed by the by the student/parent.
Volunteer Program enrollees who wish to join a middle/high school competitive extracurricular activity, athletics, cheerleading, band,
clubs/organizations or drive or park on school campus must complete the additional mandated random drug testing forms covering these
activities.
Check activities that this student participates:
Athletics – List __________________________________________________________________________
Cheerleading Academic Team
Driver and/or Parker on School Property
Competitive Clubs/Organizations: FFA FBLA FEA FCCLA HOSA Beta
NHS VICA STLP Other ______________________________________________________________
_______________________________________________
__________________________________________________________
Student Signature
____________________________________________________
Parent/Guardian Name (print)
_______________________________________________
Parent/Guardian Signature
Reviewed by Board – June 17, 2010
Page 10 of 17
Date
_________________________________________________________________
Home Phone
Work Phone
Cell Phone
_________________________________________________________________
Date
STUDENTS
09.423AP
ADAIR COUNTY SCHOOL DISTRICT
RANDOM DRUG AND ALCOHOL TESTING PROGRAM
RELEASE OF STUDENT DRUG COUNSELING INFORMATION
Student Name: ___________________________________Current Grade: ___________________________________
(Please Print)
Student ID (enter last four digits of student’s social security number):______________School: ___________________________
I, as parent or guardian or student, if over age eighteen (18), authorize and approve the release of information to District
personnel verifying the drug assessment and evaluation performed by a chemical dependency professional required following
the first Random Drug Testing offense and any additional assessments and evaluations performed thereafter. In addition, I
authorize release of records and information to verify that I am complying with the recommendations of my mandated drug
counseling program.
*This release remains in affect as long as this student is enrolled in the Random Drug Testing Program.
*Failure to provide information verifying compliance with requirements of the Random Drug Testing Policy/Procedure will
cause the student to be ineligible to participate in activities covered by the Program.
_______________________________________________
Parent/Guardian Signature
or Student (if age eighteen (18) or older)
______________________________________________
Date
Student Date of Birth _______________________________________________________
Address __________________________________________________________________
Phone Number _____________________________________________________________
Reviewed by Board – June 17, 2010
Page 11 of 17
STUDENTS
09.423AP
ADAIR COUNTY SCHOOL DISTRICT
RANDOM DRUG AND ALCOHOL TESTING PROGRAM WITHDRAWAL FORM
Student Name: ___________________________________Current Grade: ____________________________________
(Please Print)
Student ID (enter last four digits of student’s social security number):______________School: ___________________________
I, ___________________________________________________________, wish to withdraw from participation in the
(Student Name)
mandatory competitive extracurricular activities, driver and/or parker on school property or voluntary Random Drug and
Alcohol Testing Program.
I understand, I must submit this form directly to the assistant principal or counselor(s). The assistant principal will withdraw my
name from the testing pool on the date this form is received.
I also understand, by completing this withdrawal form, I will no longer be eligible to participate in any middle/high school
competitive extracurricular activities, athletics, cheerleading, school organizations/clubs (including but not limited to academic
teams, FFA, FBLA, FEA, FCCLA, HOSA, Beta, NHS, VICA and STLP) drive and/or park on school property or will no longer
be a part of the volunteer drug/alcohol testing program. I may re-enter the testing pool after a period of six (6) months by filling
out a new consent form.
Students have 15 calendar days to reconsider their decision and re-enter the drug testing pool with no drug testing
program consequences, reinstatement to the student’s previous activity is a decision made by the coach/sponsor.
*If this student is under age eighteen (18), parent consent for withdrawal is required.
Check activities that this student participates:
Athletics – List
Cheerleading Academic Team Driver and/or Parker on School Property
Competitive Clubs/Organizations: FFA FBLA FEA FCCLA HOSA
NHS VICA STLP Other
Volunteer Drug Testing Program Participant
__________________________________________________
Student Signature
Beta
Date
__________________________________________________
Parent/Guardian Name (print)
Work Phone
__________________________________________________
Parent/Guardian Signature
Date
__________________________________________________
Home Phone
Cell Phone
__________________________________________________
Principal/Assistant Principal Signature
Reviewed by Board – June 17, 2010
Page 12 of 17
Date
STUDENTS
09.423AP
ADAIR COUNTY SCHOOL DISTRICT
RANDOM DRUG AND ALCOHOL TESTING REQUEST FOR APPEAL
DISTRICT LEVEL
Student Name: ___________________________________Current Grade:
(Please Print)
Student ID (enter last four digits of student’s social security number):______________School:
I, _______________________________________________________, wish to appeal my positive drug result.
(Student Name)
I understand that parents/guardians or a student eighteen (18) years of age or older may contest a positive test result, by
presenting a written appeal to the District Drug Testing Coordinator within three (3 ) working days after receipt of the written
notice of a positive test result.
I also understand, that the parents/guardians or a student eighteen (18) years of age or older may, at the student’s expense,
request an additional drug analysis. Any additional laboratory analysis shall be conducted by the Drug Testing Company
contracted by the Adair County Board and with the student’s remaining urine specimen preserved by the Board contracted
testing laboratory.
The Superintendent/District Drug Testing Coordinator will consult with the Medical Review Officer (MRO) and review findings
of the evidence presented by the parent/guardian or student to the Drug Testing MRO Specialist during the MRO’S initial
positive test result investigation. The Superintendent will render a final decision within five (5) working days of receiving
parent/guardian or student, if age eighteen or older notice to contest the positive test result (this time line may exceed five (5)
days if needed for additional drug testing results).
*The consequences of the positive test results will be enforced during the appeal process.
Check activities that this student participates:
Athletics – List
Cheerleading Academic Team Driver and/or Parker on School Property
Competitive Clubs/Organizations: FFA FBLA FEA FCCLA HOSA
NHS VICA STLP Other
Volunteer Drug Testing Program Participant
Beta
__________________________________________________
Student Signature
Date
__________________________________________________
Parent/Guardian Name (print)
Work Phone
__________________________________________________
Parent/Guardian Signature
Date
__________________________________________________
Home Phone
Cell Phone
__________________________________________________
Principal/Assistant Principal Signature
Reviewed by Board – June 17, 2010
Page 13 of 17
Date
STUDENTS
09.423AP
ADAIR COUNTY SCHOOL DISTRICT
RANDOM DRUG AND ALCOHOL TESTING APPEAL DECISION
DISTRICT LEVEL
Date __________________________________
_________________________________________
_________________________________________
_________________________________________
Dear _____________________________________:
(Parent/guardian or student if over age 18)
After careful review of evidence presented on behalf of your child ____________________________________________, the
(student name)
District Superintendent/District Drug Testing Coordinator has made the following decision:
Your child’s positive drug test result is upheld due to a lack of clear and convincing evidence to prove the test was altered due
to medication, medical condition or procedural drug testing error(s). Consequences for this positive drug test are applicable as
set forth in Board Policy/Procedure 09.423.
In regard to evidence presented, your child’s student’s positive drug test is being changed to negative. The student must
submit to a new drug test administered in accordance with the Random Drug Testing guidelines and must continue to be in
compliance with Random Drug Testing Policy/Procedure 09.423
COMMENTS:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________
We believe the Random Drug Testing Policy helps defer drug use and is a procedural safeguard for all student participants.
If you have questions concerning the results of this appeal call 384-2476.
Please be assured of our desire for all children to enjoy extracurricular activities and receive a quality education in a safe and
drug free environment.
___________________________________________
Signature of Superintendent
____________________________________________
Signature of District Drug Testing Coordinator
Reviewed by Board – June 17, 2010
Page 14 of 17
_____________________________________
Date
_____________________________________
Date
STUDENTS
09.423AP
ADAIR COUNTY SCHOOL DISTRICT
RANDOM DRUG -TESTING PROGRAM
PARENTS/GUARDIANS NOTIFICATION
(Date)
CERTIFIED MAIL-RETURN RECEIPT REQUESTED
(Name and Address)
RE: (Student Name)
Dear __________________________________________________:
On ______________________, _____________________________ was randomly selected for drug testing
(Date)
(Student’s Name)
pursuant to the Adair County School District Random Drug Testing Policy and Procedure. The results of that test
were:
 Positive for alcohol
 Positive for the following drug(s):
The actions to be taken by the school as a result of the positive test are explained in the attached policy. Please
contact me at 384-2476 within three (3) working days from your receipt of this letter to discuss the options available
to your child.
The District's Policy and Procedure provide opportunity to contest the results of a urine drug test, by notifying
the District Drug Testing Coordinator within three (3) working days from your receipt of this letter by filling out the
District Request for Appeal Form.
The Policy under which your child was tested is an academically non-punitive policy adopted by the Adair
County Board of Education to help identify students who use drugs and to assist them in getting the counseling and
treatment they may need. I look forward to working with you, to achieve that goal.
Sincerely,
District Drug Testing Coordinator
Adair County School District
If hand delivered to parent or student age eighteen (18) or older.
I hereby acknowledge receipt of this letter:
____________________________________________
Parent Signature
____________________________________________
Student Signature (if age 18 or older)
____________________________________________
Signature of Principal/Assistant Principal
______________________________________
Date
_______________________________________
Date
_______________________________________
Date
*School Official to keep copy of letter with all official signatures.
Reviewed by Board – June 17, 2010
Page 15 of 17
STUDENTS
09.423AP
ADAIR COUNTY SCHOOL DISTRICT
RELEASE OF (18) OR OLDER STUDENT DRUG TESTING RESULTS TO
PARENT/GUARDIAN
As a student eighteen (18) years old or order, I understand that release of my random drug testing
results to my parents/guardians is my decision.
After consideration of the confidentiality of my records, I hereby authorize my random drug testing
results to be released and discussed with my parents/guardians.
_______________________________________________
Student Signature (if age eighteen (18) or older)
_________________________________________
Signature of School Official Witnessing
Student Signature
Reviewed by Board – June 17, 2010
Page 16 of 17
______________________________________________
Date of Authorization
________________________________________________
Date
STUDENTS
09.423AP
ADAIR COUNTY SCHOOL DISTRICT
MIDDLE/HIGH SCHOOL
RANDOM DRUG AND ALCOHOL TESTING PROGRAM
AND DRUG AWARENESS INFORMATIONAL MEETING
Program Facilitator _____________________________________________________________
School______________________________________ Date______________________________
STUDENT SIGNATURE
Reviewed by Board – June 17, 2010
Page 17 of 17
PARTICIPANTS
PARENT SIGNATURE