Fillable 2020-2021 Middle School Math Placement Teacher Waiver

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2020-2021 Middle School Math Placement Teacher Waiver

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2020-2021 Middle School Math Placement Teacher Waiver
2020-2021 Middle School Math Placement Teacher Waiver
By submitting this waiver, I am requesting that one of my current students be placed in a math class other than his/her
recommended placement for the 2020-2021 school year. Before making this request, I thoughtfully considered and
discussed his/her test scores, grades, classroom performance, work habits, motivation, individual learning style, and
academic needs as they pertain to math class.
STUDENT INFORMATION
Student’s Name
Student’s Grade
School Name
Student ID Number
I have reviewed the following items with the parent(s)/guardian(s) of this student:
● Requests for higher placement (without skipping content) will be reviewed by the school-based review
team. The parent/guardian has the right to participate in this process.
● When the request is approved, the student should be prepared to stay in their new placement for the full
school year. A class change later in the school year may require additional changes to the class schedule.
● Students are not permitted to transfer out of NC Math 1 after the 20th day in a year-long class due to state
policy.
● Requests for waivers for current fifth graders (rising sixth graders) are to be initially reviewed and signed by
the elementary school principal. This initial recommendation will then be sent to the middle school principal
for final placement.
● According to HB986, students who score a Level 5 on the EOG must be placed in an advanced
math course. A parent or guardian will need to provide written consent for the student to be
excluded or removed from that course.
TEACHER WAIVER INSTRUCTIONS
STUDENT/PARENT AGREEMENT
2020-2021 Middle School Math Placement Teacher Waiver
I am requesting the following change of placement to a higher placement for this student for the 2020-2021 school year.
Specifically, I am asking that this student’s placement be changed from:
(course name) to
(course name).
I discussed this placement with the parent on
(date) and attest to the fact that the parent
is supportive of this request.
Teacher Signature (
type your name
):
Date:
DENIED
After careful review, the initial request is APPROVED
The recommended course placement is
EVAAS Score EOG Score (
previous grade level
)
Elementary Principal Signature (
type your name
):
Initial
recommendation communicated to parent/guardian on (date).
In approving this waiver request, the school will agree to:
• Provide supports for the student as appropriate to promote successful completion of the course.
• Communicate with the parent and student about any areas of concern in the learning process in a timely
manner and provide strategies for improvement where needed.
After careful review, the request is APPROVED DENIED.
The final course placement is .
Principal Signature (
type your name
)
Decision communicated to parent/guardian on (date).
FOR RISING 6th GRADERS ONLY: ELEMENTARY SCHOOL INITIAL RECOMMENDATION
(NOTE: Middle School will make the FINAL Placement)
TEACHER WAIVER REQUEST
MIDDLE SCHOOL AGREEMENT
MIDDLE SCHOOL FINAL RECOMMENDATION (To be completed by Principal at the Middle School)
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2020-2021 Middle School Math Placement Teacher Waiver

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Completed 15 February 2021

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