ELE - Parent Informed Consent Form Waiver

I am knowingly and voluntarily requesting that my child receive a waiver from the requirements of G.L. c.71A, as amended (“Question 2”). I understand that if school officials grant my waiver request my child will receive bilingual instruction or some other type of language support rather than sheltered English immersion instruction. Upon my personal visit to the school, school officials provided me with a full description, in a language that I understand, of the educational opportunities available to my child.

Based on this information, which I have read and understood, I am requesting a program waiver for my child for the 2007-2008 school year. I have been fully informed of my right not to apply for or agree to a program waiver.

_________________________________

Child's Name

_________________________________ ______________________________

Parent or Guardian Signature Parent or Guardian Signature

__________________________ ________________________

Date Date

* If the Parent and Guardian Informed Consent Form is provided in a language other than English, attach that form to the waiver application.

Attachment A

Auburn Public Schools - School Year 2007 to 2008

G.L. c.71A Program Waiver

Parent or Guardian Informed Consent Form *