Graduation Exam Waiver (Sample) Form Class of 2019

Graduation Exam Waiver (Sample) Form ? Class of 2019

Student Name_________________________ Graduation Date __________Today's Date ___________

ISTEP+ Grade 10 Section(s) not passed: English/Language Arts

Math

Quick Check of Waiver Criteria Criteria 1 Test taken each year as required Criteria 2Completed recommended remediation Criteria 3 Attendance requirement met at 95% Criteria 4 GPA requirement met Criteria 5 Met other state & local requirements Criteria 6 (Check One)

6a - Evidence Based

6b - Work Readiness

Criteria 1: Test taken once per year: YES NO

ELA (pass ___) Math (pass __)

Grade 10

_____________ _____________

Grade 11

_____________ _____________

Grade 12

_____________ ______________

Add'l Testing _____________ ______________

Criteria 4: Avg of "C" in 34 required credits: YES NO

Sem 1:Grade-Pts

Sem 2:Grade-Pts

Eng 9

_______-_______

_______-_______

Eng 10 _______-_______

_______-_______

Eng 11 _______-_______

_______-_______

Eng 12 _______-_______

_______-_______

Algebra I _______-_______

_______-_______

2nd Math _______-_______

_______-_______

Biology I _______-_______

_______-_______

2nd Science _______-_______

_______-_______

US Hist. _______-_______

_______-_______

Govt/SocSt _______-_______

_______-_______

PE I and II _______-_______

_______-_______

Health _______-_______

College & Career Pathway Courses: 6 credits Selecting

electives in a deliberate manner to take full advantage of career exploration and preparation opportunities.

______-______ ______-______ ______-______

______-______ ______-______ ______-______

Flex Credits: 5 credits

______-______ ______-______ ______-______

______-______ ______-______

Waiver GPA = Total Points ________ / 34 = _______

Note that students must earn a minimum of 40 credits to earn a diploma.

Criteria 2: Completion of remediation: YES NO

ELA

Math

Gr 10 __________ Gr 11 __________

__________ Gr 12 __________

__________

__________ __________ __________ __________ __________

Criteria 3: Attendance requirement met: YES NO

UA=Unexcused Absence(s) DE=Days Enrolled

Gr 9 UA______DE_____ Total UA______

Gr 10 UA_____ DE_____ Total UA______

Gr 11 UA_____ DE_____ Total DE______

Gr 12 UA_____ DE_____ Rate: ___________ Must be 95% Rate = 100 ? (UA/DE x 100)

Criteria 5 Local graduation requirements met: YES NO

Students with an IEP are not required to complete locally required credits beyond state credit requirements.

Criteria 6a: Evidence Based Waiver:

Teacher recommendation (written). Signatures & letter combined fulfills teacher recommendation for waiver. Principal signature indicates concurrence. English Teacher_______________________________________

Math Teacher _______________________________________

Criteria 6b: Work Readiness Waiver: Completed each of the following:

General Diploma requirements (at minimum), Workforce readiness assessment, and Industry certification from SBOE's approved list

a career exploration internship course, or Principal______________a__c_o_o_p_e_ra_t_iv_e__e_d_u_ca_t_io_n__c_o_u_r_se_,_o_r_______

a workforce credential (selected by the Waiver decision per principascl:ho_o_l)__APPROVED ____ DENIED

Graduation Pathways

Postsecondary-Readiness Competency (Sample) WAIVER Form

Postsecondary-Readiness Competency Waiver, IF: Student was unsuccessful in completing a postsecondary-readiness competency by the end of the senior year &

attempted to achieve at least 3 separate postsecondary-readiness competencies; or

Student transfers to a school during the senior year from a nonaccredited nonpublic school or an out-of-state school

and attempted to achieve at least 1 postsecondary-readiness competency but was unsuccessful.

Postsecondary-Readiness Competency Waiver Checklist

Criteria 1: 3 postsecondary-readiness competencies attempted (or 1 if student transfer (see details above));

Criteria 2: GPA Requirement met Criteria 3: Attendance requirement met at 95% Criteria 4: Met all state & local requirements

(Students with an IEP aren't required to complete local requirements beyond state requirements) Criteria 5: Demonstrates postsecondary planning

Criteria 3: Attendance Requirement Met

YES

NO

UA=Unexcused Absence(s) DE=Days Enrolled

Gr 9 UA______DE_____ Total UA______

Gr 10 UA_____ DE_____ Total UA______

Gr 11 UA_____ DE_____ Total DE______

Gr 12 UA_____ DE_____ Rate: ___________

Must be 95% Rate = 100 ? (UA/DE x 100)

Criteria 1: At least 3 Postsecondary-Readiness

Competencies attempted

YES

NO

Competencies attempted; date or supporting data:

1) ________________________________

2) ________________________________

3) ________________________________

(1 if senior transfer from nonpublic or out-of-state)

Criteria 2: Avg. of "C" in 34 Required Credits

YES

NO

Sem 1:Grade-Pts Sem 2:Grade-Pts

Eng 9

_______-_______ _______-_______

Eng 10 _______-_______ _______-_______

Eng 11 _______-_______ _______-_______

Eng 12 _______-_______ _______-_______

Algebra I _______-_______ _______-_______

2nd Math _______-_______ _______-_______

Biology I _______-_______ _______-_______

2nd Science _______-_______ _______-_______

US Hist. _______-_______ _______-_______

Govt/SocSt _______-_______ _______-_______

PE I and II _______-_______ _______-_______

Health _______-_______

College & Career Pathway Courses: 6 credits. ______-______ ______-______ ______-______

______-______ ______-______ ______-______

Flex Credits: 5 credits

______-______ ______-______ ______-______

______-______ ______-______

Waiver GPA = Total Points ________ / 34 = _______

Note that students must earn a minimum of 40 credits to earn a

diploma.

Criteria 4: State & Local Graduation

Requirements Met

YES

NO

Students with an IEP are not required to complete locally required credits beyond state credit requirements.

Criteria 5: Postsecondary Planning:

YES

NO

College Acceptance;

Occupational Training Program Acceptance;

Workforce Entry; OR

Military Enlistment

__________________________________________

Principal Approval

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