Campus: Principal:

2015-2016Waiver Request Details

Certain requests for waivers or renewal of waivers require additional information such as details, evidence of efficacy, or a statement of compliance.

Please provide the additional information below according to the requested waiver(s). The principal must sign this form before submission to the Waiver Oversight Committee.

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Waiver / Information Required / Details/Evidence/Statement / Source of Data
1 Required Item / #1 High School-Modified Schedule/State Assessment Days
STATEMENT OF COMPLIANCE / A renewal of this waiver requires a statement of compliance assuring that last year all students were scheduled for at least four hours of instruction on waiver days and that this plan appears in the 2014-2015 SIP. Please provide the source of this assurance.
2 Required items / #4-Middle School – Course Requirements – Technology Applications courses Waiver of Local Board Policy EHAC (LEGAL)/ 19TAC §126.14
STATEMENT OF COMPLIANCE / A renewal of this waiver requires a statement of compliance assuring that the TEKS for Technology Applications were integrated through the curriculum that this plan appears in the 2014-2015 SIP. Please indicate how this determination was made.
#4-Middle School – Course Requirements – Technology Applications courses Waiver of Local Board Policy EHAC (LEGAL)/ 19TAC §126.14
DETAILS / A request for this waiver for the 2015-2016 school year requires a brief explanation of the implementation plan to integrate the Technology Applications TEKS into all other content areas.
2 Required Items / #5-Elementary/Middle School – Promotion Standards Waiver of Local Board Policy EIE (LOCAL)
STATEMENT OF COMPLIANCE / A renewal of this waiver requires a statement of compliance assuring that the any student promoted mid-year under this waiver met the following criteria:
  1. The student was identified as at-risk.
  2. The student was participating in a year-long accelerated instruction program.
  3. The student’s fall semester average for each of the four core courses was 70 or above.
  4. The student took the STAAR test at the new grade level in the Spring,
and that this plan appears in the 2014-2015 SIP.
#5-Elementary/Middle School – Promotion Standards Waiver of Local Board Policy EIE (LOCAL)
EVIDENCE OF EFFICACY / A renewal of this waiver requires evidence of efficacy. Please provide information related to STAAR Performance for elementary and middle schools, and dropout rate for middle schools as it relates to implementation of this waiver.
2 Required Items / #6-High School – Credits and Curriculum Waiver of Local Board Policy EIA (LOCAL)and EIC (LOCAL)
STATEMENT OF COMPLIANCE / Renewal of this waiver request requires a statement of compliance assuring that any student who was graded under a pass/fail option though this waiver was carrying a full load of AP coursework and that this plan appears in the 2014-2015 SIP.
#6-High School – Credits and Curriculum Waiver of Local Board Policy EIA (LOCAL)and EIC (LOCAL)
EVIDENCE OF EFFICACY / Renewal of this waiver request requires evidence of efficacy. Please provide information related to the increased number of students taking AP courses, the number of students requesting the pass/fail option, and the number of students participating in extra-curricular activities as it relates to implementation of this waiver.
2 Required Items / #7-High School – Final Exam Exceptions Waiver of Local School Guidelines Section XV
STATEMENT OF COMPLIANCE / Renewal of this waiver request requires a statement of compliance assuring that any student who was exempted from a final exam under this waiver took the national IB/AP exam for the course and had a current average of 90 or above and that this plan appears in the 2014-2015 SIP.
#7-High School – Final Exam Exceptions Waiver of Local School Guidelines Section XV
EVIDENCE OF EFFICACY / Renewal of this waiver request requires evidence of efficacy. Please provide information related to improved IB/AP class grades and IB/AP test results as it relates to implementation of this waiver.
2 Required Items / #12 a,b,c
Altered Student Instructional Day – Waiver of Local Board Policy EC (LOCAL)
STATEMENT OF COMPLIANCE / Renewal of this waiver request requires a statement of compliance assuring that each school day (teacher schedule) was at least 7 hours in length, that instructional time on student early release days was at least 4 hours in length, the total weekly number of instructional hours was not reduced due to this waiver and that this plan appears in the 2014-2015 SIP including the professional development of certified teachers on the early release dates.
#12 a,b,c
Altered Student Instructional Day – Waiver of Local Board Policy EC (LOCAL)
EVIDENCE OF EFFICACY / Renewal of this waiver request requires evidence of efficacy. Please provide information related to improved student learning as measured by STAAR results.
2 Required Items / CUSTOM WAIVER
STATEMENT OF COMPLIANCE / Renewal of a waiver previously approved for your campus requires a statement of compliance. Note that a custom waiver MAY have previously appeared as a General Waiver. Renewal as a custom waiver still requires this statement of compliance concerning any conditions listed in the waiver. Please consult the waiver language and provide the required statement.
CUSTOM WAIVER
EVIDENCE OF EFFICACY / Renewal of a waiver previously approved for your campus requires evidence of efficacy. Note that a custom waiver MAY have previously appeared as a General Waiver. Renewal as a custom waiver still requires evidence of efficacy concerning any expected outcomes listed in the waiver. Please consult the waiver language and provide the required evidence.

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Signature of Campus PrincipalDate

Please complete, print, sign, and submit this form along with the signature page for your waiver requests.

Items are due May 1, 2015.