THE STATE EDUCATION DEPARTMENT / THE UNIVERSITY OF THE STATE OF NEW YORK / ALBANY, NY 12234

Office of P-12

Lissette Colón-Collins, Assistant Commissioner	Office of Bilingual Education and World Languages

55 Hanson Place, Room 594	89 Washington Avenue, Room 528 EB

Brooklyn, New York 11217	Albany, New York 12234

Tel: (718) 722-2445 / Fax: (718) 722-2459	(518) 474-8775 / Fax: (518) 474-7948

School District Waiver 2016-2017

One Year Exemption from Providing Bilingual Education Programs

in Languages other than Spanish and Chinese

This form is to be used by school districts that are seeking an exemption from providing Bilingual Education (BE) programs in languages spoken by less than 5% of the total statewide ELL population (any language other than Spanish or Chinese*). A district may apply for this exemption on an annual basis for no more than five consecutive years, if it does not have qualified staff to operate a BE program in a language other than Spanish or Chinese, for all eligible students at either the district level or at one or more schools that are required to offer a BE program.

In order to be granted this exemption, districts must:

Demonstrate the efforts that are being made to recruit qualified bilingual teachers in the languages other than Spanish and Chinese that are needed to establish bilingual programs and the plans for ongoing and intensive efforts to recruit qualified BE teachers in that language; and

A plan for how the district will provide alternate home language supports in the form of bilingual teacher assistants/aides and/or heritage language programs and make such home language supports available for all students who would otherwise be enrolled in a BE program.

Fill out all required fields below and all fields that apply. Forms that are incomplete must be resubmitted or will not be considered for review.

Section 1. District Information

Date:
District Name:
BEDS Code:
Street:
City:	Zip Code:
Name of the Person Completing the Form:	Email:	Phone:
Title:

School year for which you are applying for the exemption:
Is this the first time you are applying for the exemption? Note: districts may be granted this exemption for no more than five consecutive school years.	Yes No
If not the first time, then indicate the number of years you have previously been granted the exemption:

*Currently, Spanish and Chinese are the only two languages that are each spoken by more than 5% of the total statewide ELL population.

Section 2: Student and Program Information

Please provide the following information for all BE programs for which you are requesting an exemption:

School Name	School BEDS code	Grade(s)	Language of BE Program	Number of currently enrolled students eligible for a BE program in this language	Number of teachers available in your district qualified to teach the BE program	Check if enrollment is lower than expected	Check if enrollment is higher than expected

Section 3: Narrative

For the questions below, you may use the fill in fields and attach documents as necessary.

Summarize, in detail, and provide evidence of the efforts that the district has made to recruit qualified bilingual teachers in the languages needed for the BE programs for which an exemption is sought. Include the plans that the district and the school, as applicable, have for ongoing and intensive efforts to recruit qualified bilingual teachers. This might include canvassing current staff regarding their interest in applying for certification and collaborating with local Institutions of Higher Education.

Submit a plan for how the district will provide alternate home language supports in the form of bilingual teacher assistants/aides and/or heritage language programs and make such home language supports available for all students who would otherwise be enrolled in a Bilingual Education program.

Section 4: Signature/Certification

Sign this form and submit by November 30th, 2016 as follows: Submit electronically to: OBEWLDocSubmit@nysed.gov Please place the form name and district name in the email subject heading: “BE Program Waiver, <insert name of LEA>”
Superintendent/Chief Administrative Officer or designee electronic signature. By entering your name below, you are signing this form electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this form.
Name:	Title:	Date:
Email:
To be completed by the Office of Bilingual Education and World Languages Waiver Request Approved Not Approved, revisions needed. Please revise and resubmit by:
Comments: