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ELE - Waiver Form English Students Under 10
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File contents
A. Background Information
1. Name of Student |
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2. Date of Birth |
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3. Date Student Was Placed In An English Language Classroom |
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4. Date Parent(s)/Guardian(s) Visited School to Apply For A Waiver (at least 30 calendar days AFTER student was placed in an English Language classroom) |
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Parent or Guardian Informed Consent: Parents or guardians must review and sign the Parent or Guardian Informed Consent Form (Attachment A). This form must be provided in a language the parent or guardian understands. The signed Informed Consent Form should be attached to this form.
Determination Regarding Waiver Request:
Waiver request approved (school officials must sign here and complete Attachment B): It is our informed belief that an alternate course of educational study is better suited to the student's overall educational progress and rapid acquisition of English. The student will be placed in a transitional bilingual class on __________________.
_______________________________ ______________________________
School Superintendent (signature/date) School Principal (signature/date)
Waiver request denied (school officials must sign here): It is our informed belief that an alternate course of educational study would NOT be better suited to the student's overall educational progress and rapid acquisition of English.
_______________________________ ______________________________
School Superintendent (signature/date) School Principal (signature/date)
D. Appeals Process (optional): If the waiver is denied and if the district guidelines contain an appeals process, did the parent(s) or legal guardian(s) appeal the decision? If yes, what was the final determination of the school officials?
Auburn Public Schools - School Year 2005 to 2006
G.L.c.71A School District Program Waiver Application Form for English Learners
Students Under 10 Years of Age
