California Department of Education

California Gold Ribbon Schools Program

2016-17Exemplary Arts EducationApplication

Part I

Cover Page

County-District-School (CDS) Code

CountyName

District Name

School Name (If your school is selected for honors, this school name will be engraved on the award plaque.)

Mailing AddressCity and Zip Code

Area Code and Phone NumberExt.Area Code and Fax Number

Principal’s E-mail Address

Winter Break (Alternate) Contact NameArea Code and Phone NumberExt.

I certify that I have reviewed the information contained in this application and, to the best of my knowledge, it is complete and accurate. I further certify that:

  • The Office for Civil Rights does not have any outstanding findings of civil rights statute violations by the school or district that may affect the school;
  • There are no pending lawsuits by the Department of Justice against the district alleging that the school, or the district as a whole, has violated one or more of the civil rights statutes or the Constitution’s equal protection clauses; and
  • The school or district is addressing or has addressed any identified areas of noncompliance under federal or state laws and regulations.

Principal’s NamePrincipal’s SignatureDate

District Superintendent’s NameDistrict Superintendent’s SignatureDate

(or authorized designee)

Posted on November 8, 2016

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Posted on November 8, 20162016-17Exemplary Arts Education Application

School Demographics

  1. Total school enrollment:
  1. Which category best describes where your school is located?

UrbanSuburbanRural

  1. What is your school calendar?TraditionalYear-roundModified
  1. Is your school a charter school?YesNo
  1. Number of full-time and part-time staff members in each of the categories below:

Full-time StaffPart-time Staff

Administrators

All classroom teachers

Arts (VAPA) orCareer Technical Arts, Media

and Entertainment (AME) teachers

Counselors

Credentialed librarians

Nurses

Psychologists

Technology/media specialists or technicians

Paraprofessionals

Campus resource officers

Other staff (specify)

Total staff

Arts and/or Arts, Media and Entertainment(AME)Education Demographics

  1. Number of Arts/AMEcourses, labs, and program spaces

Number of

ArtsCourses

Art

Dance

Music

Theatre (including Technical Theatre)

Media Arts

Totalcourses

  1. Number of students currently enrolled in your Arts and/or AME program and schoolwide at each grade level: Complete all grade levels appropriate to your school site

Number ofNumber of

Students inStudents

Arts/AMESchoolwide

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12

Other (fifth-year seniors, etc.)

Total

  1. Percent of students in your Arts/AME program and schoolwide by race/ethnicity based on current year data:

Percent ofPercent of

Students inStudents

Arts/AME ProgramSchoolwide

American Indian/Alaska Native% %

Asian% %

Black or African American% %

Filipino% %

Hispanic or Latino% %

Native Hawaiian/Pacific Islander% %

White% %

Two or More Races% %

Total 100.0%100.0%

Directions to Your School

If your school is selected as a statewide nominee, the site visit team members will need directions to your school.

County

District

School

Street AddressCity and Zip Code

PrincipalArea Code and Phone NumberExt.

Name and Location of the Nearest Airport

Major Freeway Access

Provide detailed travel directions indicating the surface streets that lead to your school. Please do not submit directions or a map generated by an Internet Web site.

(Response limited to this page)

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Posted on November 8, 20162016-17Exemplary Arts Education Application

ArtsEducationSynopsis

(School Name)

(Vision Statement from school or district Arts plan)

Arts or AME synopsis narrative (limited to this page)

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