Part I: District Information

Texas Education Agency

Community-Based Fine Arts Program Approval Request

Part I: District Information

Date of submission: District/Charter school: County District Campus Number (CDCN): Contact person: Contact person's e-mail address: Contact person's phone number: Superintendent: School year approval will become effective:

Part II: Certification of Program Requirements

The commissioner of education may approve a program that meets the requirements for community-based fine arts programs, pursuant to Texas Education Code (TEC) ?28.025(b-9) and 19 Texas Administrative Code (TAC), Chapter 74, Subchapter BB.

A. For each requirement below, please indicate compliance with an "X" in the appropriate box.

Requirements

Yes No

The school district or charter school has certified that the program provides instruction in all

of the essential knowledge and skills for one course as defined by 19 TAC, Chapter 117,

Texas Essential Knowledge and Skills for Fine Arts, Subchapter C, High School.

The program is organized and monitored by appropriately trained instructors.

The district or charter school will document student completion of the approved program.

Students will not be dismissed from any part of the regular school day to participate in the program.

B. Enter the date the school district or charter school certified that the community-based fine arts program provides instruction in all of the essential knowledge and skills for a fine arts course as defined by 19 TAC, Chapter 117, Subchapter C.

Date of certification:

Part III: Program Information

Entity Providing Program

TEKS-based Program

Program Site (On or Off-campus)

Part IV: Criminal History Requirement

In accordance with 19 TAC, Chapter 74, Subchapter BB, districts and charter schools must require that instructors of a community-based fine arts program provide the school entity, at its request, the information necessary to obtain the criminal history record information required for school personnel, if the program is offered on campus.

Please mark the space provided below to confirm that the criminal history requirement for on-campus programs has been reviewed.

The criminal history requirement for on-campus programs has been reviewed.

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