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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