Student’s Name: Student ID#:
I hereby request that my student be removed from English Language Development services.
I have been informed of:
_____ How my student was identified for English Language Development services.
_____ The English language proficiency level of my student.
_____ The exit requirements of English language development services.
_____ How these services are designed to help my student learn English and meet age-appropriate academic achievement standards, which will help my student to be successful in school and meet requirements for graduation.
_____ Other English language development services or methods of instruction available in the district for my student.
Northshore School District has communicated the benefits of its English language development services to me and the reasons that the district recommends my student’s placement in these services. I am aware that my student has not met the exit requirements and is not considered by the district to be sufficiently proficient in English to succeed in mainstream classrooms without support through ELD services. I understand that I have the right to withdraw this written refusal of services at any time and request that my student be immediately placed back into services.
In compliance with federal requirements, my student will continue to be tested on the state’s annual language proficiency assessment until my student meets exit requirements established by the State of Washington.
Name of Parent/Guardian
Parent/Guardian Signature Date