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