Attachment F
Page 1 of 1
EXEMPLARY COMPONENTS CHECKLIST
The following list of exemplary components is intended to provide the review team with an
overview of the applicant school.
Each component is described in general terms. Use your best judgment in determining
whether or not the school offers each component. There will be an opportunity to clarify the
details of each checked component if a Site Validation Visit is scheduled.
Key in “Yes” to the corresponding “Component Type” if it is offered at the applicant school,
otherwise, key in “No.” Please describe any additional components that support the applicant
school in providing exemplary practices on a separate page. (See p. 14 of the application
packet for specific formatting instructions.)
Component Type
Is this
component
offered?
(Yes or No)
1. Curriculum aligned to state and district standards
2. Individual student data system that informs students, staff, and families
3. District referral process
4. Data-driven continuous improvement model
5. Comprehensive range of educational options offered in the district
6. Shared decision making at district and school levels
7. Student Success Team model or a variation thereof
8. Individual Learning Plan for each student
9. Instructional strategies differentiated to meet the needs of students
10. Senior project/portfolio or similar project
11. High rate of parent/guardian/caregiver and stakeholder involvement
12. Yearbook or other student publication(s)
13. Art and/or music program(s)
14. Student government
15. Reading and/or writing across curriculum
16. Physical education/sports programs
17. Co-curricular and extra-curricular activities
California Department of Education April 2021
