Rockingham County Schools Middle School Math Placement
Parent Waiver Form, 2015-2016 School Year
General Information
Parents may submit a waiver form to the school principal to request either a higher placement or a lower placement in mathematics. In order to request a waiver, the parent should:
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Download the waiver form from this site or pick up a hard copy of the form at their school.
Forms are returned to the child’s school principal.
School level review teams will review the requests and submit a recommendation to the district review team.
The district review team will review the information, along with the parent/guardian, and will make a decision on placement.
Principals cannot approve waiver requests that including skipping content.
What is the purpose of the waiver process?
Because we know that EVAAS, EOGs, and even classroom grades only give a school a "paper" look at the student to guide the decision, there are instances where the parent feels that the placement should be different. The waiver is intended to individualize this process for students to receive this feedback from parents, to ensure that informed choices are being made, and to ensure that parents know supports available to their students.
The approved waiver also indicates an important partnership between the family, who commits to supporting the learning process and communicating needs and the school, who commits to providing appropriate supports for success and communicating regularly with the family on how they can be involved in supporting the learning process.

Rockingham County Schools Middle School Math Placement
Parent Waiver Form, 2015-2016 School Year
By submitting this waiver, I am requesting that my child be placed in a math class other than his/her recommended placement for the 2015-2016 school year. Before making this request, my child and 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. I understand that I should have attached a letter outlining my request for the waiver and the reasons I believe my child should be placed in a class other than the one recommended by the school.
Student Information
Student Name: Current Grade: 6 7
School Name (Current):
Parent/Guardian Name and Address:
Student ID #:
Phone #: Work:
Cell:
Home:
Parent Email:
Student/Parent Agreement
Please review the following information regarding the math placement waiver process:
1.
I understand that the school-level review team will review requests for higher placement and a recommendation will be made to the district-level review team. The parent/guardian has the right to participate in the review process at the district level and will be a team member on the district-level review team. Participation on the district-level review team is required for parent/guardians of the child.
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If 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.
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Students are not permitted to transfer out of Math I after the 20 th day on a traditional schedule due to state testing requirements and policy.
Requests for waivers for current fifth graders (rising 6 th graders) are to be reviewed by the school-level team at the elementary school where the child is in attendance.
Waiver Request
I am requesting the following change in placement for my child for the 2015-2016 school year:
Specifically, I am asking that my child’s placement be changed from_________________________(course name) to
___________________________(course name).
Parent/Guardian Signature: ______________________________________________ Date:________________________
Print Parent/Guardian Name: ____________________________________________
District-Level Team Decision
Date of District-Level Review team meeting: __________________________
After careful consideration and review, this request is APPROVED DENIED. The final course placement is
___________________________.
Assistant Superintendent Signature: __________________________________________________________________
Director of Special Programs Signature: _______________________________________________________________
Chief Academic Officer for Elementary Schools Signature: ________________________________________________
Chief Academic Officer for Secondary Schools Signature: _________________________________________________
Parent/Guardian Signature: __________________________________________________________________________