Provision of □ Educational 401.140 (b) Program Classroom age - (temporary) 226.720 (b) Class size □ Deviation - for a unique circumstance occurring during the school year allowing enrollment in the classroom to increase to seven (7) students with one (1) licensed special education teacher (temporary) 401.140 (c) □ Deviation - for general class size beyond class size limits within 401 Rules AGE RANGE /CLASS SIZE DEVIATION APPLICATION Planned Deviation Initiation Date: _____________________ Classroom Name: _____________________________ (mm/dd/yyyy) Planned Deviation End Date: ____________________ Classroom Teacher: ____________________________ (mm/dd/yyyy) Complete the chart below for the classroom requesting the deviation. Please insert the additional student’s information for the proposed new student in the STUDENT” box. “ADDED □ □ □ Pre-School (ages 3 6 years) Elementary Level (K-8) Secondary Level (9-12+) – STUDENT # DOB (mm/dd/yyyy) DISABILITY 1 2 3 4 5 6 7 8 9 10 ADDED STUDENT STUDENT DOB (mm/dd/yyyy) DISABILITY AGE DIFFERENCE Please provide a response for all questions in the rationale section below. Incomplete applications will not be accepted. AGE RANGE / CLASS SIZE RATIONALE Describe the direct cause for this request.
Provision of Educational Program □ 401.140 (b) 226.720 (b) Classroom age - (temporary) □ □ 401.140 (c) Class size Deviation - for a unique circumstance occurring during the school year allowing enrollment in the classroom to increase to seven (7) students with one (1) licensed special education teacher (temporary) Deviation - for general class size beyond class size limits within 401 Rules AGE RANGE /CLASS SIZE DEVIATION APPLICATION Planned Deviation Initiation Date: _____________________ Classroom Name: _____________________________ (mm/dd/yyyy) Planned Deviation End Date: ____________________ Classroom Teacher: ____________________________ (mm/dd/yyyy) Complete the chart below for the classroom requesting the deviation. Please insert the additional student’s information for the proposed new student in the “ADDED STUDENT” box. □ Pre-School (ages 3 – 6 years) □ Elementary Level (K-8) □ Secondary Level (9-12+) STUDENT # DOB (mm/dd/yyyy) DISABILITY 1 2 3 4 5 6 7 8 9 10 ADDED STUDENT STUDENT DOB (mm/dd/yyyy) DISABILITY AGE DIFFERENCE Please provide a response for all questions in the rationale section below. Incomplete applications will not be accepted. AGE RANGE / CLASS SIZE RATIONALE Describe the direct cause for this request.
np-deviation-request-form.docx