October 15, 2015 (X) Action Required Due Date: November 30, 2015 (X) Informational BULLETIN NO. 055-15 TITLE I/LAP AND CONSOLIDATED PROGRAM REVIEW TO: Educational Service District Superintendents School District Superintendents Elementary and Secondary School Principals School District Curriculum/Assessment Directors School District Title I, Part A Directors FROM: Randy I. Dorn, State Superintendent of Public Instruction RE: N<30 Adequate Yearly Progress School Improvement Plan Submission and Schools with No Population Tested on the Statewide Assessment CONTACT: Paula Moore, Director, Title I/LAP and Consolidated Program Review 360-725-6100, paula.moore@k12.wa.us Agency TTY: 360-664-3631 The Elementary and Secondary Education Act (ESEA) of 2001 requires Adequate Yearly Progress (AYP) determinations in mathematics and reading for each public school in the state. ESEA further requires that states establish a minimum subgroup size of students assessed to ensure that reliable AYP determinations are made. For the proficiency determinations, students must be continuously enrolled from October 1, through the assessment period. In accordance with ESEA, AYP determinations must be made in all schools, even if they have fewer than 30 students in the “all students” group. The state’s AYP Accountability Plan reads: “Any school and district that would not be held accountable using the AYP definition (i.e., N of 0–29) will be held accountable through the approval of their School Improvement Plan by the local school board pursuant to WAC 180-16-220, and an annual review by the Office of Superintendent of Public Instruction (OSPI) to determine goal attainment.” This requirement also applies to schools with no population tested on the statewide assessment. BULLETIN NO. 055-15 TI/LAP&CPR Page 2 October 15, 2015 The School Improvement Plan (SIP) process and submission information are detailed in Attachment A. Requirements for the SIP are listed in Attachment B. Attachment C contains 1) Schools with a population tested on the statewide assessment that is less than 30 students; and 2) Schools with no population tested on the statewide assessment. Send SIPs to OSPI for each school listed for your district as shown in Attachment C. If Attachment C contains a school that has not been appropriately identified, email Julie Chace at julie.chace@k12.wa.us, stating the reason. SIPs must be submitted electronically to julie.chace@k12.wa.us, no later than November 30. Attachment D is the N<30 SIP Feedback Form and Attachment E is the N<30 SIP Assurance Form. If you have questions regarding this bulletin or attachments, please contact Paula Moore, Director of Title I/LAP and Consolidated Program Review at 360-725-6100 or email paula.moore@k12.wa.us. You may also contact Larry Fazzari, Title I/LAP Program Supervisor at 360-725-6189 or email larry.fazzari@k12.wa.us. The agency’s TTY number is 360-664-3631. This bulletin is also available on OSPI’s website at: http://www.k12.wa.us/BulletinsMemos/bulletins2015.aspx. K–12 EDUCATION Gil Mendoza, Ed.D. Deputy Superintendent SPECIAL PROGRAMS AND FEDERAL ACCOUNTABILITY Gayle Pauley Assistant Superintendent Paula Moore, Director Title I/LAP and CPR RD:PM:jc Attachment A: Attachment B: Attachment C: Attachment D: Attachment E: SIP Process Requirements for SIP WAC 180-16-220 List of Schools Required to Submit SIPs N<30 SIP Feedback Form N<30 SIP Assurance Form OSPI provides equal access to all programs and services without discrimination based on sex, race, creed, religion, color, national origin, age, honorably discharged veteran or military status, sexual orientation including gender expression or identity, the presence of any sensory, mental, or physical disability, or the use of a trained dog guide or service animal by a person with a disability. Questions and complaints of alleged discrimination should be directed to the Equity and Civil Rights Director at (360) 725-6162 or P.O. Box 47200 Olympia, WA 98504-7200 ATTACHMENT A School Improvement Plan Process The State Board of Education requires the development of a School Improvement Plan (SIP). Further, WAC 180-16-220 requires SIPs to be approved by each district’s local school board. The requirement to submit a SIP to OSPI applies only to schools that have less than 30 continuously enrolled students in the “all students” reading and math proficiency categories or for schools with no population tested on the statewide assessment. Submission of the SIP for review is a component of our federally-approved state accountability plan. Due Date and Plan Submission For each school identified, the school district will coordinate the following: If your school is newly-identified, submit the entire SIP by November 30. If your identified school(s) submitted a SIP to OSPI in 2014–15 and you have changes to your plan for 2015–16, indicate the changes on the N<30 SIP Feedback Form (Attachment D), sign and date assuring your annual review, and submit only Attachment D to OSPI by November 30. If your school(s) submitted a SIP to OSPI in 2014–15 and NO changes were required, review the plan, sign and date the N<30 SIP Assurance Form (Attachment E), and submit only Attachment E to OSPI by November 30. Submit plans electronically to Julie Chace at julie.chace@k12.wa.us. Please include the district name in the subject line of your email submission. If the plan is not available in electronic format, send a hard copy to Julie Chace, Title I/LAP and Consolidated Program Review, PO Box 47200, Olympia, WA, 98504-7200. Districts must provide the requested information by the above date; otherwise, schools will be determined to not have made AYP for the 2015–16 school year. Plans are required from all schools listed in Attachment C. SIP Review Process OSPI will review each SIP to ensure that all elements are complete and will then provide specific feedback to the school/district. SIP Components SIP components are found in WAC 180-16-220, which can be viewed at: http://apps.leg.wa.gov/WAC/default.aspx?cite=180-16-220. The required components are summarized in Attachment B. ATTACHMENT B School Improvement Plan Requirements WAC 180-16-220 The checklist below contains the required elements for a SIP under WAC 180-16-220. SIPs are subject to review by OSPI. This checklist is intended as a tool to assist in preparation of the SIP and should not be submitted to OSPI. 1. Evidence and date of annual school board approval. 2. Evidence staff certification requirements were met. 3. Evidence the plan is based on self-review and participation of required participants (staff, students, families, parents, and community members). 4. Brief summary of use of data to establish improvement. 5. Plan promotes continuous improvement in student achievement of state learning goals and essential academic learning requirements (EALRs). 6. Recognition of non-academic student learning, what, and how. 7. Plan addresses characteristics of successful schools. 8. Plan addresses educational equity (gender, race, ethnicity, culture, language, and physical/mental ability). 9. Plan addresses use of technology to facilitate instruction. 10. Plan addresses parent, family, and community involvement. Buildings and districts with N<30 or schools that do not have Smarter Balanced Assessment (SBAC)-tested grades who do not submit the required SIP will not make AYP. Failure to make AYP for two consecutive years will result in identification for school improvement beginning with Step 1. The consequences associated with each step are detailed at: http://www.k12.wa.us/TitleI/AYP/default.aspx. ATTACHMENT C District Code 29103 17408 18303 18303 06119 06119 17405 17405 37501 37501 37501 37501 01122 37503 37503 18100 18100 24111 09075 16046 04228 18401 32356 32356 21302 32360 32360 33036 16049 02250 02250 19404 27400 27400 District Anacortes Auburn Bainbridge Island Bainbridge Island Battle Ground Battle Ground Bellevue Bellevue Bellingham Bellingham Bellingham Bellingham Benge Blaine Blaine Bremerton Bremerton Brewster Bridgeport Brinnon Cascade Central Kitsap Central Valley Central Valley Chehalis Cheney Cheney Chewelah Chimacum Clarkston Clarkston Cle Elum-Roslyn Clover Park Clover Park School Code 5176 1915 1841 1939 5360 5382 5281 5308 1694 1799 5340 5366 3142 4459 4476 1749 5395 5272 1900 2836 4566 5199 5328 5068 5369 1769 5035 1709 4552 3616 1933 1987 1880 1881 Building Name Cap Sante High School Special Ed School Mosaic Home Education Partnership Bainbridge Special Education Services Open Doors Battle Ground Summit View Middle School Central Educational Services Jing Mei Elementary School Home Port Learning Center Visions (Seamar Youth Center) Bellingham Re-Engagement Program Bellingham Family Partnership Program Benge Elementary Point Roberts Primary Blaine Primary School Bremerton Home Link Program Career & Academic Re-engagement Center Brewster Alternative School Bridgeport Aurora High School Brinnon Elementary Beaver Valley School CK Online Academy Graduation Alliance Central Valley Central Valley Kindergarten Center Lewis County Alternative School Three Springs High School HomeWorks Chewelah Alternative Chimacum Creek Primary School Special Services Elementary Alternative Center Swiftwater Learning Center Re-Entry High School Re-Entry Middle School School Type A S A S R P P P A A R A P P P A P A A P P A R P A A A A P S A A A A Total Tested 27.00 2.00 6.00 2.00 5.00 0.00 5.00 26.00 5.00 19.00 4.00 0.00 4.00 5.00 0.00 21.00 0.00 12.00 11.00 27.00 7.00 20.00 4.00 0.00 9.00 29.00 13.00 5.00 0.00 1.00 0.00 26.00 1.00 6.00 Grade Span 9–12 PK–12 K–8 PK–12 9–12 7–8 PK–13 K–5 9–12 6–12 9–12 K–12 K–6 K–3 K–2 K–8 10–12 9–12 9–12 K–8 K–4 9–12 10–13 K–K 6–12 9–12 K–12 8–12 K–2 PK–12 K–8 9–12 9–12 6–8 ATTACHMENT C District Code 27400 33206 33115 32931 29011 29011 13151 10050 19007 32414 36101 09206 19028 27404 27404 31015 31015 31015 19401 14068 17216 32801 34801 21036 31002 31002 31002 31002 33205 17906 17210 17210 17210 17210 District Clover Park Columbia (Stevens) Colville Community Colleges Concrete Concrete Coulee-Hartline Curlew Damman Deer Park Dixie Eastmont Easton Eatonville Eatonville Edmonds Edmonds Edmonds Ellensburg Elma Enumclaw ESD 101 ESD 113 Evaline Everett Everett Everett Everett Evergreen (Stevens) Excel Public Charter Federal Way Federal Way Federal Way Federal Way School Code 5297 5283 2957 5304 1605 1762 2304 1921 2077 2430 2278 5228 5242 5332 5300 1519 1830 3818 5097 1629 1523 3507 5305 2355 1663 3903 5330 5414 3197 5377 1951 4340 5255 5348 Building Name Transition Day Students Columbia Alternative School Hofstetter Elementary Institute for Extended Learning Twin Cedars High School Skagit River School House Coulee City MS Curlew Parent Partner Damman Elementary Deer Park Elementary Dixie Elementary School Eastmont Columbia Virtual Academy Easton Secondary School New Beginnings Mt. Rainier Parent Partnership Edmonds eLearning Academy Special Education Contracted Maplewood Center K-12 Ellensburg Learning Center East Grays Harbor High School Special Ed School Structural Alt Confinement School GRAVITY High School Evaline Elementary School NW Learning Center Special Services Everett Reengagement Academy Other Schools Evergreen School Excel Public Charter School Support School Merit School Gateway to College Open Doors Youth Reengagement (1418) School Type P A P P A A P A P P P A P R A A S S A A S A R P A S R P P P P S Z R Total Tested 8.00 0.00 0.00 0.00 1.00 1.00 0.00 1.00 17.00 0.00 9.00 0.00 0.00 6.00 0.00 24.00 11.00 9.00 9.00 15.00 2.00 1.00 1.00 21.00 4.00 5.00 7.00 0.00 6.00 0.00 2.00 1.00 11.00 8.00 Grade Span 5–12 9–12 K–2 9–12 10–12 K–12 6–8 K–12 K–5 K–2 PK–5 K–12 7–12 9–12 K–8 9–12 4–12 K–12 PK–12 9–12 PK–12 8–12 11–13 K–6 9–12 PK–12 9–12 K–12 K–6 6–7 PK–12 6–12 9–12 9–12 ATTACHMENT C District Code 17210 37502 27417 17901 27402 38302 38302 38302 20401 20401 13301 39200 31332 32312 27904 17401 17401 17401 17401 17401 14028 31063 17411 11056 10003 08458 08458 17415 06101 38126 04129 04129 31004 District Federal Way Ferndale Fife First Place Scholars Franklin Pierce Garfield Garfield Garfield Glenwood Glenwood Grand Coulee Grandview Granite Falls Great Northern Green Dot Public Schools Highline Highline Highline Highline Highline Hoquiam Index Issaquah Kahlotus Keller Kelso Kelso Kent La Center LaCrosse Lake Chelan Lake Chelan Lake Stevens School Code 5107 2263 2878 5341 5324 1962 2895 2896 3047 3048 5336 1776 5349 2097 Building Name Federal Way Running Start Home School Beach Elem Discovery Primary School First Place Scholars Charter School Gates Open Doors Program Garfield at Palouse High School Garfield Elementary Garfield Middle School Glenwood Elementary Glenwood Secondary The American Academy Contract Learning Center Granite Falls Open Doors Great Northern Elementary School Type P P P P R P P P P P A A R P 5378 1973 5172 5254 5277 5371 2268 2948 1624 3214 2602 1934 5194 1807 5326 2087 1940 3861 4140 Green Dot Tacoma Middle School Satellite High School Puget Sound High School Gateway to College Southwest Youth and Family Services Highline Home School Center Emerson Elementary Index Elementary School Issaquah Special Services Kahlotus Elem & High Keller Elementary School Loowit High School Kelso Virtual Academy Regional Justice Center La Center Home School Academy Lacrosse Elementary School Chelan School of Innovation Holden Village Community School Prove High School P S A A Z A P P S P P A P A A P P P A Total Tested 0.00 12.00 1.00 20.00 6.00 15.00 25.00 28.00 18.00 29.00 7.00 26.00 21.00 25.00 0.00 2.00 17.00 0.00 0.00 0.00 0.00 15.00 3.00 21.00 12.00 25.00 13.00 1.00 16.00 13.00 4.00 10.00 0.00 Grade Span 11–12 K–5 PK–1 K–5 9–12 9–12 PK–5 6–8 K–6 7–12 K–12 9–12 9–12 K–6 6–8 PK–12 11–12 10–13 9–12 K–12 K–1 PK–8 PK–12 PK–12 K–6 9–12 8–12 9–12 K–12 K–8 9–12 K–12 9–12 ATTACHMENT C District Code 17414 17414 17414 17937 01158 33183 28144 20406 33207 33207 33207 33207 31025 32326 24350 24350 30031 31103 21206 39209 37507 29320 31006 39003 26056 11051 11051 18400 23403 23403 17417 17417 29801 15201 District Lake Washington Lake Washington Lake Washington Lake Washington TC Lind Loon Lake Lopez Lyle Mary Walker Mary Walker Mary Walker Mary Walker Marysville Medical Lake Methow Valley Methow Valley Mill A Monroe Mossyrock Mount Adams Mount Baker Mount Vernon Mukilteo Naches Valley Newport North Franklin North Franklin North Kitsap North Mason North Mason Northshore Northshore NW ESD 189 Oak Harbor School Code 1649 1804 3856 5306 2903 1922 4178 5274 1819 1820 5267 1857 1910 5042 1621 1845 3406 1643 5415 5233 5112 3829 1848 2897 5118 1754 5261 3126 1680 1861 1815 5331 1811 5343 Building Name Contractual Schools Futures School Community School Gateway to College at LWIT Lind-Ritzville High School Loon Lake Homelink Program Decatur Elementary Envista Academy of Washington Parent Partner Program Mary Walker Alternative High Schl Digital Electronic Contact Mary Walker P Springdale Academy Marysville Special Medical Lake Alternative High School Alternative School Home School Experience Mill A Elementary School Out Of District Special Ed Mossyrock Academy American Academy Mount Baker Academy Mount Vernon Special Ed Special Services Naches Valley Primary School Pend Oreille River School Palouse Junction High School North Franklin Virtual Academy Middle School Options PACE Academy (OPTIONS) North Mason Homelink Program Northshore Special Services Northshore Online School Pass Program iGrad Academy School Type A A A R P A P A A A A A S A A A P S A Z A S S P A A A P A A S R A R Total Tested 9.00 16.00 0.00 0.00 22.00 1.00 1.00 0.00 12.00 1.00 10.00 0.00 10.00 23.00 15.00 9.00 12.00 2.00 0.00 0.00 18.00 4.00 12.00 0.00 10.00 27.00 2.00 27.00 26.00 16.00 4.00 7.00 0.00 9.00 Grade Span K–12 9–12 1–5 11–12 9–12 K–8 K–8 K–12 9–12 K–12 K–12 PK–13 9–12 9–12 K–12 K–8 PK–11 7–12 9–12 K–12 K–12 PK–12 K–2 K–12 9–12 K–12 6–8 9–12 K–12 PK–12 9–12 6–12 9–12 ATTACHMENT C District Code 38324 24105 24105 34111 24019 21300 33030 28137 32123 10065 10065 09102 38301 11001 11001 11001 11001 11001 21301 05121 32907 03116 27003 27003 27003 27003 16020 16048 05402 05402 17908 22009 17403 District Oakesdale Okanogan Okanogan Olympia Omak Onalaska Onion Creek Orcas Island Orchard Prairie Orient Orient Palisades Palouse Pasco Pasco Pasco Pasco Pasco Pe Ell Port Angeles PRIDE Prep Charter School Prosser Puyallup Puyallup Puyallup Puyallup Queets-Clearwater Quilcene Quillayute Valley Quillayute Valley Rainier Prep Charter Reardan-Edwall Renton School Code 2432 1980 5151 5078 4279 5146 2049 3808 3723 2136 5155 2502 2634 5177 5391 5392 5393 5394 1925 1715 5339 1728 5321 5322 3114 5073 2491 5081 1500 1671 5380 5237 1534 Building Name Oakesdale High School Okanogan Alternative High School Okanogan Outreach Alternative School Olympia Regional Learning Academy Highlands High School CVA - Onalaska Onion Creek Elementary Waldron Island School Orchard Prairie Elementary Orient Elem Columbia Virtual Academy-Orient Palisades Elementary School Palouse High School Captain Gray Early Learning Center Barbara McClintock STEM Elementary Captain Gray STEM Elementary Internet Pasco Academy of Learning Marie Curie STEM Elementary Trojan Alternative School Parents As Partners PRIDE Prep School Technology and Science Prosser Falls Education Center Open Doors Puyallup Puyallup Parent Partnership Program Riverside Elementary Quest Queets-Clearwater Elementary Crossroads Community School Forks Alternative School District Run Home School Rainier Prep Reardan Online Academy Griffin Home School Type P A A A A A P P P P A P P P P P A P A A P A R A P A P A A A P A S Total Tested 18.00 8.00 17.00 27.00 19.00 4.00 22.00 6.00 0.00 15.00 3.00 16.00 27.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 29.00 19.00 19.00 0.00 0.00 10.00 3.00 12.00 6.00 0.00 0.00 5.00 Grade Span 7–12 9–12 6–12 K–12 9–12 K–12 PK–8 1–8 K–7 K–8 K–8 K–5 9–12 K–6 K–6 K–8 3–6 9–12 K–8 6–12 9–12 9–12 K–8 K–6 K–6 K–8 9–12 9–12 K–12 5–8 3–12 6–12 ATTACHMENT C District Code 17403 17403 17403 10309 17407 17407 34401 20403 13160 28149 17001 17001 17001 17001 17001 39119 39119 39119 39119 39119 28010 17412 17404 17404 31201 31201 31201 31201 17410 13156 27909 25118 32901 District Renton Renton Renton Republic Riverview Riverview Rochester Roosevelt Royal San Juan Island Seattle Seattle Seattle Seattle Seattle Selah Selah Selah Selah Selah Shaw Island Shoreline Skykomish Skykomish Snohomish Snohomish Snohomish Snohomish Snoqualmie Vally Soap Lake SOAR Academy Charter South Bend Spokane International School Code 1648 5335 1527 1898 1756 5244 1735 3530 5388 1963 1750 4263 4277 5046 5405 5231 5334 5383 5384 5385 3725 1667 2512 2513 1730 3981 1757 2446 5296 1518 Building Name Out Of District Facility Open Door Youth Reengagement Renton Sartori Education Center Republic Parent Partner CLIP Choice H.e.a.r.t. High School Roosevelt Elementary School Royal Intermediate School Griffin Bay School Education Service Centers Residential Consortium Hutch School Private School Services Interagency Open Doors Selah HomeLink Selah Academy Reengagement Prog John Campbell Primary School Selah Intermediate School Selah Middle School Shaw Island Elementary School Handicapped Contractual Services Skykomish Elementary School Skykomish High School Snohomish Center High School Re Entry Snohomish Online Learning Central Elementary Snoqualmie Parent Partnership Program Smokiam Alternative High School School Type S R A A A P A P P A A S A S R P R P P P P S P P S A A P A A 5379 5247 5381 SOAR Academy Public Charter School Pacific County Jail Spokane International Academy Elementary P A P Total Tested 8.00 2.00 0.00 9.00 17.00 11.00 15.00 16.00 0.00 4.00 12.00 20.00 1.00 5.00 0.00 16.00 0.00 0.00 0.00 0.00 12.00 6.00 12.00 10.00 10.00 10.00 0.00 0.00 29.00 17.00 0.00 0.00 0.00 Grade Span PK–12 11–12 9–12 K–12 9–12 7–10 9–12 1–6 4–6 K–12 6–12 PK–12 PK–12 PK–12 9–12 K–8 9–12 K–2 3–5 6–8 K–8 PK–12 PK–8 9–12 K–12 9–12 7–12 K–2 K–12 9–12 K–8 9–12 K–6 ATTACHMENT C District Code 32081 32081 District Spokane Spokane School Code 1603 4286 32081 32081 22008 22008 31401 11054 07035 04069 27001 38304 30303 30303 31311 17902 27905 39201 27010 27010 27010 27010 34402 21237 20400 17406 17406 34033 27083 33070 06037 06037 06037 Spokane Spokane Sprague Sprague Stanwood Star Starbuck Stehekin Steilacoom Hist. Steptoe Stevenson-Carson Stevenson-Carson Sultan Summit Public School Summit Public School Sunnyside Tacoma Tacoma Tacoma Tacoma Tenino Toledo Trout Lake Tukwila Tukwila Tumwater University Place Valley Vancouver Vancouver Vancouver 5344 1698 2186 3050 5108 2007 2135 2265 2040 2115 5318 2682 5329 5375 5376 5137 1797 4283 5192 5183 2457 5190 3062 5284 5315 5014 1790 5223 4524 5342 5258 Building Name Daybreak Alternative School Sacred Heart Hospital Open Doors Youth Re-Engagement Spokane SCCP Images Sprague High School Sprague Elementary Lincoln Academy Star Elem School Starbuck School Stehekin Elementary Anderson Island Elementary Steptoe Elementary School Columbia Gorge School Stevenson Elementary Open Doors Youth Reengagement Sultan Summit Public School: Sierra Summit Public School: Olympus Sun Valley Elementary Day Reporting School Pearl Street Center Special Services Tacoma Business Academy Parkside Elementary Cowlitz Prairie Academy Trout Lake Elementary Gateway Youthsource New Market High School University Place Special Educ Paideia High School Vancouver Alternative Programs Open Doors Vancouver Vancouver Contracted Programs School Type A S R A P P A P P P P P A P R P P P A S A A P P P A R A S P P R P Total Tested 4.00 1.00 24.00 0.00 19.00 15.00 15.00 0.00 13.00 5.00 20.00 26.00 9.00 0.00 2.00 0.00 0.00 0.00 19.00 9.00 18.00 0.00 0.00 29.00 22.00 0.00 0.00 27.00 6.00 25.00 4.00 16.00 0.00 Grade Span 8–12 3–12 9–12 12 9–12 K–4 6–8 2–5 K–8 K–8 K–5 PK–8 K–12 K–2 9–12 9–12 9–12 K 9–12 6–12 PK–12 9–12 K–2 7–12 K–4 9–12 9–12 10–12 K–12 9–12 6–12 9–12 9–12 ATTACHMENT C District Code 17402 17402 13073 01109 04246 04246 27416 27416 20405 08404 08404 08404 39007 39007 17946 District Vashon Island Vashon Island Wahluke Washtucna Wenatchee Wenatchee White River White River White Salmon Valley Woodland Woodland Woodland Yakima Yakima School Code 1822 1938 1835 3075 1612 5316 5338 1544 5077 3513 5408 5409 5224 5355 5962 Building Name Family Link Student Link Sentinel Tech Alt School Washtucna Elementary/High School Skill Source Open Doors Wenatchee White River Reengagement Program Collins Alternative Programs White Salmon Academy Yale Elementary Woodland Intermediate School Woodland Middle School Yakima Satellite Alternative Programs Yakima Open Doors SSCC High School Completion School Type A A A P A R R A A P P P A R P Total Tested 12.00 9.00 14.00 27.00 0.00 0.00 10.00 0.00 10.00 29.00 0.00 0.00 20.00 10.00 0.00 Grade Span K–12 9–12 9–12 K–12 9–12 9–12 9–12 9–12 K–5 2–4 5–8 8–12 9–12 9–13 ATTACHMENT D N<30 School Improvement Plan (SIP) Feedback Form District Name: _________________________________________________________ School Name: _________________________________________________________ Contact Name:_________________________________________________________ Contact Number: __________________ Email: ______________________________ Annual Review Date of SIP: ______________________________________________ Changes to SIP: (List all changes made to the plan). ____________________________________________________________________ Signature of Authorized Representative Date ____________________________________________________________________ Print First/Last Name Title Return the form by November 30, to: Julie Chace Title I/LAP and CPR PO Box 47200 Olympia, WA 98504-7200 julie.chace@k12.wa.us ATTACHMENT E N<30 School Improvement Plan (SIP) Assurance Form District Name: _________________________________________________________ School Name: _________________________________________________________ Contact Name:_________________________________________________________ Contact Number: __________________ Email: _______________________________ Annual Review Date of SIP: ______________________________________________ ____________________________ school has NO changes to their SIP for 2015–16. ____________________________________________________________________ Signature of Authorized Representative Date ____________________________________________________________________ Print First/Last Name Title Return the form by November 30, to: Julie Chace Title I/LAP and CPR PO Box 47200 Olympia, WA 98504-7200 julie.chace@k12.wa.us