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Atascadero USD |  E  6162.52  Instruction

High School Exit Examination   

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Parent Guardian Request For Waiver Of The Requirement To Successfully Pass The High School Exit Examination For A Student With Disabilities

Please return the completed form to the principal of your student's high school.

My student is a student with disabilities attending Atascadero High School. He/she has taken the high school exit examination with modifications that later what the test measures and has received the equivalent of a passing score on one or more parts of the exam.

I hereby request that the principal submit a request to the Board of Trustees for a waiver of the requirement that my student successfully pass the exit examination in order to receive a high school diploma.

I understanding that, in order to receive such a waiver, state law requires that my student possess all of the following:

1. An individualized education program (IEP) adopted pursuant to the Individuals with Disabilities Education Act or a plan adopted pursuant to Section 504 of the Rehabilitation Act of 1973 that requires the modification to be provided when taking the high school exit exam.

2. Sufficient high school level coursework either satisfactorily completed or in progress in the Atascadero High School curriculum sufficient to have attained the skill and knowledge otherwise needed to pass the high school exit examination.

3. An individual score report showing that my student has achieved the equivalent of a passing score on the exit exam while using a modification that fundamentally alters what the exam measures as determined by the State Board of Education.

Date:________________

Parent/Guardian Signature:_______________________________________________________

PRINCIPAL'S CERTIFICATION AND REQUEST FOR THE BOARD OF TRUSTEES TO WAIVE OF THE REQUIREMENT TO SUCCESSFULLY PASS THE HIGH SCHOOL EXIT EXAMINATION FOR A STUDENT WITH DISABILITIES PURSUANT TO EDUCATION CODE 60851

Student's Name:_______________________________________________________________

Student's Number:_____________________________________________________________

The parent/guardian of , a child with disabilities, has requested that the Board of Trustees of Atascadero Unified School District waiver the requirement that his/her child successfully pass the high school exit examination in order to receive a diploma from Atascadero High School. His/her child has taken the high school exit examination with a modification, as determined by the State Board of Education, that fundamentally alters that the test measures and has achieved the equivalent of a passing score on one or both part of the exam.

I certify that the student qualified for a waiver because he/she satisfies all of the following conditions:

1. Has an individualized education program (IEP) adopted pursuant to the Individuals with Disabilities Act or Section 504 plan that requires the modification to be provided to the student when taking the high school exit examination. (Attach the IEP or 504 plan that indicates the modification needed to participate and access the high school exit exam.)

a. Describe the nature of the student's disability as identified on the IEP or 504 plan:

b. Describe the modification used on the English/Language arts section of the exam and/or the math section of the exam:

c. List the rationale as to why the modification used was necessary to allow the student to access the test;

2. Has sufficient high school level coursework either satisfactorily completed or in progress in the Atascadero High School curriculum sufficient to have attained the skill and knowledge otherwise needed to pass the high school exit examination. (Attach transcript showing coursework completed.)

a. Summarize the student's academic preparation and performance that demonstrates high school level achievement:

3. Has an individual score report showing that he/she has achieved the equivalent of a passing score on the exit exam (350 or more points) using a modification that fundamentally alters what the exam measures. (Attach a copy of the exit exam Student and Parent Report showing "equivalent of a passing score" in either the English/language arts/and/or math portion of the exam.)

Certified by:_______________________________________ Date:___________________

Principal's Signature:___________________________________________________________

Exhibit ATASCADERO UNIFIED SCHOOL DISTRICT

version: March 18, 2003 Atascadero, California