A r c h i v e d  I n f o r m a t i o n

Application for Waivers - August 1995


District _____________________________
Site ____________________
Year ______
Date Approved ______________________

OREGON DEPARTMENT OF EDUCATION
Public Service Building
255 Capitol Street NE
Salem, OR 97310-0203
(503) 378-3573

Oregon 21st Century Schools Program
and
Federal Educational Flexibility Demonstration Program

Application for Waiver

District Information

(Complete pages A-2 through A-5 of this application for each site participating in this project)

Application Period:
___ 1 year ___ 2 years ___ 3 years ___ 4 years ___ 5 years

District Information

District Name/Number _______________________ County ______________________
Superintendent _____________________________ Phone _______________________
Address _________________________________________
________________________________________________

If a District Planning Committee has been formed, list the chairperson, members and group each represents.
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

Statement of Assurances

This is to certify that the 21st Century Schools Program in the ________________________ School District shall meet the following conditions:

Upon notification of approval the district will certify that:

  1. The proposal has been approved by the school board and is consistent with existing district policies, rules and contracts bargained under ORS 243.650 to 243.782.

  2. The establishment of each 21st Century Schools Council is consistent with ORS 329.535 to 329.605.

  3. If a district planning committee has been formed, its establishment is consistent with ORS 329.535 to 329.605.

  4. The 21st Century Schools Council will submit a written report, signed by the local district superintendent, annually by June 15 using the form supplied by the Oregon Department of Education. Districts receiving approval after January 1 may wait until the following June before submitting their first report.

________________________________________ Date_______________________
Signature of Superintendent

________________________________________ Date_______________________
Signature of School Board Chairperson

Form 581-2124a-C (Rev 7/95)


-###-
[Table of Contents] [Waiver Proposal]