Fillable APPLICATION FOR DEVIATION APPROVAL INSTRUCTIONS SPECIAL EDUCATION DEPARTMENT (Illinois State Board of Education)

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APPLICATION FOR DEVIATION APPROVAL INSTRUCTIONS SPECIAL EDUCATION DEPARTMENT (Illinois State Board of Education)

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ISBE 34-38A (6/20)
Superintendent Authorization of Application (page 1)
• Complete all information on page 1.
• A separate authorization must be completed for each individual class or section for which an application
for deviation is being submitted.
• Name of contact for application should be someone who is knowledgeable about the application, be able
to answer any additional questions and/or provide requested information, as applicable.
• Must be signed by Superintendent or State Approved Special Education Director.
70/30 Class Composition Application
Rationale (page 2)
• Complete all information for each individual class or section for which an application for deviation is
being submitted.
General Education Teacher Assessment Overview (page 3 - OPTIONAL)
• Complete all information; a separate page should be submitted for each class or section if a teacher
has more than one class or section for which an application for deviation is being submitted.
Special Education Co-teacher Assessment Overview (page 4 - OPTIONAL)
• Only submitted if a co-teacher is assigned to the class or section
• Complete all information; a separate page should be submitted for each class or section if a teacher
has more than one class or section for which an application for deviation is being submitted.
If teachers choose to submit input, a teacher may provide the assessment form to the district for submission or
may choose to submit directly to ISBE. If submitted separately, teacher input must be received by ISBE within
7 calendar days of the district application date received by ISBE.
Submission of Application
• Applications are expected to be submitted prior to implementation of a classroom out of compliance with
rule 226.730. Approvals will be granted based on date received by ISBE.
• Only those pages applicable to the application should be submitted; an application cannot be considered
until all applicable pages have been received by ISBE.
Electronic Submission
• Forms must be printed, signed and scanned for submission to include the original signature on all
applicable pages.
• E-mail forms to DEV@isbe.net
US Mail
Illinois State Board of Education
Special Education Department
100 North First Street, N-253
Springeld, Illinois 62777-0001
100 North First Street
Springeld, Illinois 62777-0001
APPLICATION FOR DEVIATION
APPROVAL INSTRUCTIONS
SPECIAL EDUCATION DEPARTMENT
ISBE 34-38A (6/20)
SUPERINTENDENT AUTHORIZATION
70/30 CLASS COMPOSITION DEVIATION APPLICATION
DEMOGRAPHIC INFORMATION
DISTRICT NAME AND NUMBER NAME OF CONTACT FOR APPLICATION
NAME OF SUPERINTENDENT CONTACT ADDRESS (if dierent from district)
ADDRESS (Street, City, State, Zip Code) CONTACT TITLE
NAME OF BUILDING/ATTENDANCE CENTER CONTACT E-MAIL
NAME OF BUILDING PRINCIPAL CONTACT TELEPHONE
NAME OF CLASSROOM TEACHER GRADE/SUBJECT OF CLASS
______________________________________________________________
Superintendent or State Approved Director of Special Education
______________________________________________________________
Title
______________________________________________________________
Original Signature
______________________________________________________________
Date
Page 1 of 4
100 North First Street
Springeld, Illinois 62777-0001
APPLICATION FOR DEVIATION
APPROVAL INSTRUCTIONS
SPECIAL EDUCATION DEPARTMENT
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ISBE 34-38A (6/20)
ILLINOIS STATE BOARD OF EDUCATION
70/30 CLASS COMPOSITION DEVIATION APPLICATION RATIONALE
TEACHER GRADE/SUBJECT
TOTAL # IEPS
(MINUS S/L ONLY)
TOTAL # WITHOUT
IEPS
(PLUS S/L ONLY)
TOTAL
ENROLLMENT
PERCENTAGE
WITH IEPS
CO-TEACHER CO-TEACHER NAME
DATE ON WHICH
DEVIATION INITIATES
DATE ON WHICH
DEVIATION WILL END
Yes No
DISTRICT NAME AND NUMBER SCHOOL/ATTENDANCE CENTER NAME
Complete all information for each individual class or section for which an application for deviation is being submitted.
Describe how the placement of students in a general education setting based on the IEP team’s decision regarding FAPE in the LRE
resulted in a classroom out of compliance with 23 IAC 226.730.
Describe options that were considered by the district to remain in compliance with 23 IAC 226.730 and why the district believes
being granted a deviation from this rule will not negatively impact the students placed in this classroom versus a classroom in
compliance with rule.
Describe how the district has provided supports for the classroom teacher to enable him or her to meet the specic needs of the
students with disabilities as they arise from each student’s disability.
If this classroom has a co-teacher or para-professional support, describe specically the roles and expectations of each in supporting
the classroom teacher and students with disabilities in the class.
Page 2 of 4
ISBE 34-38A (6/206)
ILLINOIS STATE BOARD OF EDUCATION
70/30 CLASS COMPOSITION DEVIATION APPLICATION
GENERAL EDUCATION TEACHER ASSESSMENT OVERVIEW (OPTIONAL)
TEACHER GRADE/SUBJECT
TOTAL # IEPS
(MINUS S/L ONLY)
TOTAL # WITHOUT
IEPS
(PLUS S/L ONLY)
TOTAL
ENROLLMENT
PERCENTAGE
WITH IEPS
DISTRICT NAME AND NUMBER SCHOOL/ATTENDANCE CENTER NAME
Complete all information; a separate page should be submitted for each class or section if teaching more than one class or
section for which an application for deviation is being submitted. A teacher may provide this form to the district for submission,
or may choose to submit directly to ISBE via email (DEV@isbe.net) or U.S. mail (Illinois State Board of Education, Special
Education Services, 100 North First Street, N-253, Springeld, IL 62777). The form must include the original signature of the
teacher lling out the form.
If teachers choose to submit input, a teacher may provide the assessment form to the district for submission or may choose to
submit directly to ISBE. If submitted separately, teacher input must be received by ISBE within 7 calendar days of the district
application date received by ISBE.
______________________________________________________________
Original Signature
______________________________________________________________
Date
Describe any changes in delivering instruction that will be necessary to meet the needs of additional students with disabilities in this
classroom.
Describe how the district has provided you support to meet the specic needs of the students with disabilities. What additional supports,
if any, have you requested to support the students in this classroom; how did the district respond?
Describe how you collaborate with, and are provided support by special educators to serve students in this classroom. If this classroom
has a co-teacher or classroom para-professional, describe specically your and their roles and expectations regarding supporting
students with disabilities in the class.
Are space, materials and supports adequate to safely serve all students in the classroom? If no, explain.
Page 3 of 4
ISBE 34-38A (6/20)
TEACHER GRADE/SUBJECT
TOTAL # IEPS
(MINUS S/L ONLY)
TOTAL # WITHOUT
IEPS
(PLUS S/L ONLY)
TOTAL
ENROLLMENT
PERCENTAGE
WITH IEPS
DISTRICT NAME AND NUMBER SCHOOL/ATTENDANCE CENTER NAME
ILLINOIS STATE BOARD OF EDUCATION
70/30 CLASS COMPOSITION DEVIATION APPLICATION
SPECIAL EDUCATION CO-TEACHER ASSESSMENT OVERVIEW (OPTIONAL)
Describe any changes in delivering instruction that will be necessary to meet the needs of additional students with disabilities in this
classroom.
Describe how the district has provided you support to meet the specic needs of the students with disabilities. What additional supports,
if any, have you requested to support the students in this classroom; how did the district respond?
Describe how you collaborate with, and are provided support by special educators to serve students in this classroom. If this classroom
has a co-teacher or classroom para-professional, describe specically your and their roles and expectations regarding supporting
students with disabilities in the class.
Are space, materials and supports adequate to safely serve all students in the classroom? If no, explain.
Complete all information; a separate page should be submitted for each class or section if teaching more than one class or
section for which an application for deviation is being submitted. A teacher may provide this form to the district for submission,
or may choose to submit directly to ISBE via email (DEV@isbe.net) or U.S. mail (Illinois State Board of Education, Special
Education Services, 100 North First Street, N-253, Springeld, IL 62777). The form must include the original signature of the
teacher lling out the form.
If teachers choose to submit input, a teacher may provide the assessment form to the district for submission or may choose to
submit directly to ISBE. If submitted separately, teacher input must be received by ISBE within 7 calendar days of the district
application date received by ISBE.
______________________________________________________________
Original Signature
______________________________________________________________
Date
Page 4 of 4
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APPLICATION FOR DEVIATION APPROVAL INSTRUCTIONS SPECIAL EDUCATION DEPARTMENT (Illinois State Board of Education)

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Completed 13 August 2021

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