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

Application for Waivers - August 1995

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

Building Site Information

Site Name and Classification ________________________________________________
(e.g., elementary, middle school, junior high, senior high)

Address ______________________________________ Phone ____________________
_____________________________________________
Principal ______________________________________ Phone ____________________

List the chairperson and members of the building 21st Century Schools Council and group each represents.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Statement of Assurances

This is to certify that the 21st Century Schools Program at the building site shall meet the following conditions:

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

2. The building 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.

_________________________________________
Signature of 21st Century Schools Council Chair

____________________
Date

_____________________
Telephone Number

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

[Waiver Proposal]

[Definitions]