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Petaluma City Schools |  E  6174  Instruction

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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 Code: Telephone: ____________________

For School Use Only:

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

_____________________________________________

This Waiver is Hereby Granted/Denied:____________________________

Signature: Date:

Exhibit PETALUMA CITY SCHOOLS

version: September 28, 1998 Petaluma, California

revised: June 25, 2002

________________________________________________________________________________

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 Code: ________________Telephone: _______________

For School Use Only:

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

This Waiver Is Hereby Granted/Denied:_______________________________________

Signature:_______________________ Date: ___________________________

Exhibit PETALUMA CITY SCHOOLS

version: September 28, 1998 Petaluma, California

revised: June 25, 2002

________________________________________________________________________________

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 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 Code: ____________Telephone: ________________-

For School Use Only:

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

__________________________________________________________

Waiver Granted/Denied:

_______________________________________________________

Signature: Date:

Exhibit PETALUMA CITY SCHOOLS

version: June 25, 2002 Petaluma, California