Blake School District
Exhibit

  E 6174 
Instruction

  Education For English Language Learners

PARENTAL EXCEPTION WAIVER
EDUCATION CODE 311(a):  Children who know English

Name:_________________________________	Grade:_________

School:_______________________________	Date of Birth:_____

Language Designation:_____________________

My child possesses good English language skills and for that reason I request a waiver of the school's Structured/Sheltered English language   program.  I understand that the objective for my child is to be taught English as rapidly and effectively as possible.

I have personally visited the school to apply for this waiver. 

I have been provided a full written description of:  the intent and content of the structured English immersion program; any alternative courses of study offered by the district and made available to my child; all educational opportunities offered by the district and made available to my child; and the educational materials to be used in the different educational program choices.  

I understand that I must request that this waiver be reconsidered annually, each school year.

Parent/Guardian Signature:  ___________________  Date:_________

Address:_________________________________________________

City:________________________   State:_______  Zip:___________

Phone Number:________________

For School Use Only:

Child's English standardized test scores:  Scores must be at or above the state average for the child's grade level or above the 5th grade average:
________________________________________

Waiver Granted/Denied:__________________________  Date:_______

Signature: ______________________________________________

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Exhibit 2

PARENTAL EXCEPTION WAIVER
EDUCATION CODE 311(b):  Children age 10 or older

Name:_______________________________		Grade:_______

School:_______________________________	Date of Birth:_____

Language Designation:_____________________

My child is 10 years of age or older and I believe that an alternate course of study is better suited to my child's rapid acquisition of English.  For that reason, I request a waiver of the school's Structured/Sheltered English language program.  I understand that the objective for my child is to be taught English as rapidly and effectively as possible.

I have personally visited the school to apply for this waiver. 

I have been provided a full written description of:  the intent and content of the structured English immersion program; any alternative courses of study offered by the district and made available to my child; all educational opportunities offered by the district and made available to my child; and the educational materials to be used in the different educational program choices.  

I understand that I must request that this waiver be reconsidered annually, each school year.

Parent/Guardian Signature:  ___________________  Date:________

Address:___________________________________

City:________________________   State:_______  Zip:___________

Phone Number:________________

For School Use Only:

Waiver Granted/Denied:  _____________  Date:________________

Signature: ______________________________________________

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Exhibit 3

PARENTAL EXCEPTION WAIVER
EDUCATION CODE 311(c):  Children with Special Needs

Name:_______________________________		Grade:_______________

School:_______________________________	Date of Birth:____________

Language Designation:_____________________

I believe that my child has special needs and that an alternate course of study is better suited to his/her educational development.  (Check all that apply and provide a brief statement)

__Educational Needs ___Physical Needs ___Emotional/Psychological Needs

________________________________________________________________

________________________________________________________________

Therefore, I request a waiver of the school's Structured/Sheltered English language program.  I understand that the objective for my child is to be taught English as rapidly and effectively as possible.  I have personally visited the school to apply for this waiver. 

I understand that my child must be placed in an English language classroom for 30 calendar days and that this waiver will be considered by the Superintendent/Principal/Teacher pursuant to Board-established guidelines.

I have been provided a full written description of:  the intent and content of the structured English immersion program; any alternative courses of study offered by the district and made available to my child; all educational opportunities offered by the district and made available to my child; and the educational materials to be used in the different educational program choices.  

I understand that I must request that this waiver be reconsidered annually, each school year.

Parent/Guardian Signature:  ___________________  Date:________

Address:______________________________________________________

City:________________________   State:_______  Zip:___________

Phone Number:________________

For School Use Only:

Waiver Granted/Denied:  _____________  Date:________________

Signature: ______________________________________________