#####  U.S. Department of Education September 2003

**2003-2004**

***No Child Left Behind --***

***Blue Ribbon Schools Program***

Introduction 2

Application 8

-   Part I -- Eligibility Certification 9

-   Part II -- Demographic Data 10

-   Part III -- Summary 13

-   Part IV -- Indicators of Academic Success 13

-   Part V -- Curriculum and Instruction 13

-   Part VI -- Private School Addendum 14

-   Part VII -- Assessment Results 15

OMB Control Number: 1860-0745

Expiration Date: November 30, 2005

**2003-2004 *No Child Left Behind -- Blue Ribbon Schools Program***

**Introduction**

**A Recognition Program for American Schools**

At the beginning of the 2001-2002 school year, President Bush made an
unequivocal commitment to education:

> *Because I believe every child can learn, I intend to ensure that
> every child does learn. My Administration put forward a plan called*
> No Child Left Behind *based on four principles: accountability for
> results; local control and flexibility; expanded parental choice; and
> effective and successful programs. We are pursuing these principles
> because too many of our schools fail to help every child learn.*

The *No Child Left Behind* legislation expanded on the notion of
accountability for results:

> *States, school districts, and schools must be accountable for
> ensuring that all students, including disadvantaged students, meet
> high academic standards. States must develop a system of sanctions and
> rewards to hold districts and schools accountable for improving
> academic achievement.*

To reward successful schools, Secretary Paige has established the *No
Child Left Behind \-- Blue Ribbon Schools Program* to honor those
elementary and secondary schools in the United States that make
significant progress in closing the achievement gap or whose students
achieve at very high levels. The program recognizes and presents as
models both public and private elementary and secondary schools that
meet either of two assessment criteria.

First, it recognizes schools that have at least 40 percent of their
students from disadvantaged backgrounds and have dramatically improved
student performance to high levels in reading (language arts or English)
and mathematics on state assessments or assessments referenced against
national norms in at least the last grade tested, as determined by the
Chief State School Officer (CSSO). Second, it recognizes schools,
regardless of their demographics, that are in the top 10 percent of
schools in the state as measured by state tests of reading (language
arts or English) and mathematics or that score in the top 10 percent in
the state on assessments referenced against national norms at a
particular grade in at least the last grade tested.

These *No Child Left Behind -- Blue Ribbon Schools* will be honored at a
Washington, DC ceremony. In addition, the winning applications will be
posted on the Department of Education Web site and the Secretary may
identify educational practices that have been successful in closing the
achievement gap.

**Nomination Process for Public Schools**

For public schools, the Secretary sends a letter of invitation to each
CSSO, including the Department of Defense Schools (DoDEA) and the Bureau
of Indian Affairs (BIA), requesting that the CSSO send the Department
the names of those schools in the state that meet the criteria for
recognition. Each state or other entity is assigned a number of possible
schools based on the number of students and the number of schools in the
state.

The CSSO must insure that the schools meet the criteria for recognition
before sending their names to the Secretary. The nomination criteria,
including assessments, must pertain equally to all schools nominated
from the individual state. Based on state data, the CSSO certifies that
the submitted schools meet one of two criteria: 1) dramatic improvement
in test scores to high levels in the past three years in reading
(language arts or English) and mathematics for schools that draw at
least 40 percent of their students from disadvantaged backgrounds, or 2)
regardless of a school's demographics, achievement in the top 10 percent
of schools in the state as measured by state tests of reading (language
arts or English) and mathematics or in the top 10 percent in the state
on assessments referenced against national norms in at least the last
grade tested.

"Dramatically improved" is defined by the CSSO of each state based on
the state's definition of adequate yearly progress (AYP). All student
groups, including disadvantaged students, must show dramatic improvement
as shown by disaggregated data.

"High levels" is defined by the CSSO of each state, but at a minimum
includes student achievement in the highest grade tested at least at the
55^th^ percentile on state assessments even if the school makes AYP.

A student from a "disadvantaged background" is defined as one who is
eligible for free or reduced-priced meals at the school, is limited
English proficient, is a migrant student, or is a student receiving
services under Title I of the Elementary and Secondary Education Act, as
amended by the *No Child Left Behind Act of 2001.*

At least one-third of the schools submitted by each state must have 40
percent of the students from disadvantaged backgrounds, whether the
schools show dramatic improvement in closing the achievement gap or are
high performing (in the top 10 percent). For example, if a state may
submit seven schools and does submit seven, at least three must be high
poverty schools. States may not submit schools that have been in school
improvement status within the last two years.

Once the Secretary has the nominations from the CSSO, the U. S.
Department of Education (Department) invites the nominated schools to
submit applications for possible recognition as a *No Child Left Behind
-- Blue Ribbon School.*

The following chart demonstrates the type of schools the Secretary
wishes the CSSO to identify. In Figure 1, the trend lines of Washington
Elementary School (a hypothetical school) show significant improvement
in student achievement scores for all student groups on the state
criterion-referenced tests over five years. The Secretary is eager to
recognize schools that have shown such success in closing the
achievement gap.

In addition to recognizing schools that have shown dramatic improvement,
the Secretary wishes to identify those schools that consistently perform
in the top 10 percent on state tests or in the top 10 percent of the
schools in the state on assessments referenced against national norms.
Although schools nominated as high performing do not have to meet the 40
percent disadvantaged requirement, the Secretary is very interested in
recognizing high performing schools with a high percentage of
disadvantaged students.

## Figure 1

***NO CHILD LEFT BEHIND -- BLUE RIBBON SCHOOL***

**Grades K-5 (sample data)**

**Percentage Passing on State Tests**

![](media/image1.wmf)

**Process for Private Schools:**

For private schools, the Secretary sends a letter of invitation to the
Council for American Private Education (CAPE) requesting that CAPE send
the Department the applications of those private schools that meet the
criteria for recognition. CAPE must insure that the schools meet the
criteria for recognition before sending those names to the Secretary. In
submitting the applications, CAPE certifies that, based on state
assessments or assessments referenced against national norms at a
particular grade, the schools meet one of two criteria: 1) dramatic
improvement in test scores to high levels in the past three years in
reading (language arts or English) and mathematics for schools that have
at least 40 percent of their students from disadvantaged backgrounds, or
2) regardless of a school's demographics, achievement in the top 10
percent in the nation on assessments of reading (language arts or
English) and mathematics referenced against national norms or in the top
10 percent of schools in the state as measured by state tests in at
least the last grade tested.

A student from a "disadvantaged background" is defined as one who is
eligible for free or reduced-priced meals at the school, is limited
English proficient, is a migrant student, or is a student receiving
services under Title I of the Elementary and Secondary Education Act, as
amended by the No Child Left Behind Act of 2001.

For information on the CAPE nomination process and timeline, private
schools should consult the CAPE website at
http://www.capenet.org/brs.html.

**Eligibility**

Public and private schools, including schools in Puerto Rico, the Bureau
of Indian Affairs Schools, and the Department of Defense Education
Agency, with some configuration that includes grades between
kindergarten and grade 12 and that meet the eligibility requirements
described in this application are eligible to participate in the program
each year. Each state or agency is assigned a number of possible
applicants based on the number of K-12 students and the number of
schools in the state. The number of possible state applicants ranges
from a minimum of 3 schools to a maximum of 35. CAPE may nominate 50
private schools. The potential total for all nominations is 420.

Eligible schools are those nominated by the CSSO or CAPE that meet the
criteria defined in the "Eligibility Certification" on page 10 and in
Part VII -- Assessment Results and have completed the entire
application.

**The Application Process for Nominated Schools**

Once the Department receives the nominations from the CSSOs, the
Secretary extends an invitation to the nominated schools to apply. In
keeping with the principles of the *No Child Left Behind* *Act*, the
application focuses primarily on results and scientifically based
instructional programs. The completed application will be approximately
10-12 pages, excluding data tables.

Since the Department will usually not conduct site visits of individual
schools, it is very important that the CSSO and CAPE adequately screen
nominees to ensure that they represent the state or CAPE well, and will
be excellent models of best practices for the *No Child Left Behind --
Blue Ribbon Schools Program.* The Secretary reserves the right to
initiate site visits to some schools to document their excellent
practices as well as to verify the accuracy of data.

**Timelines 2003-2004**

September 23: The Secretary sends a letter of invitation to the Chief
State School Officers and CAPE requesting the submission of information
for nominated schools.

November 7: Responses are due from the CSSO to the Secretary.

November 21: The Department sends letters of invitation with
applications to the schools recommended by the CSSO.

February 11: Completed applications from the public schools are due to
the Department.

September 10: The Secretary announces the 2004 *No Child Left Behind --
Blue Ribbon Schools.*

Fall 2004 A Washington, DC ceremony honors the schools.

**Paperwork Burden Statement**

According to the Paperwork Reduction Act of 1995, no persons are
required to respond to a collection of information unless such
collection displays a valid OMB control number. The valid OMB control
number for this information collection is 1850-0745. The expiration date
is 11/30/2005. The time required to complete this information collection
is estimated to average 40 hours per response, including the time to
review instructions, search existing data resources, gather the data
needed, and complete and review the information collection. If you have
any comments concerning the accuracy of the time estimate(s) or
suggestions for improving this form, please write to: U.S. Department of
Education, Washington, DC 20202-4651. If you have comments or concerns
regarding the status of the individual submission of this form, write
directly to: *No Child Left Behind -- Blue Ribbon Schools Program*, U.S.
Department of Education, 400 Maryland Avenue SW, 5E205, Washington DC
20202-3521.

**Technical Specifications**

Please keep the following requirements in mind when completing the
application. Failure to comply will result in the school\'s application
not being reviewed.

1.  **Eligibility.** To be eligible, the school must completely fill in
    the cover sheet and all sections of the application. For example,
    the school must give a street address even if the mailing address is
    a post office box number, provide the nine-digit zip code, the
    school's Web address, and the e-mail address. Incomplete
    applications, either paper or electronic, will be returned to the
    school.

2.  **Paper, Spacing, and Type Size**. All responses must be typed on
    white paper, single-spaced, with one-inch margins on right, left,
    top, and bottom. Use normal spacing between lines, as in the example
    in the box below.

> Print size must not be reduced smaller than 11-point computer font,
> the same physical size as the Times New Roman font used in this box.
> Do not use condensed or compressed type; the font style used should be
> easily reproducible.

3.  **Copies**. Each school submits two copies (the original plus one)
    of the completed application. The original and copies must be
    without any additional covers or folders and stapled in the upper
    left-hand corner. The signed original should be printed on one side.
    To minimize environmental impact, the copy may be photocopied on
    both sides of the paper. The application should have no additional
    plastic cover page or backing, nor be placed in a folder, nor have
    attachments other than assessment data.

4.  **Electronic Files**. The school also submits the application
    electronically in one file by sending it as an attachment that
    contains the entire application (including the cover sheet and data
    tables) to an e-mail address to be supplied to nominated schools.
    The file must be written in Microsoft Word in PC format. The Word
    and PDF versions of the application are on the Department's website.

5.  **Cover Sheet**. Note that the cover sheet requires the signatures
    of the principal, the district superintendent, and the
    president/chairperson of the local school board. These signatures
    certify that each of the three individuals has reviewed the content
    of the application, including the statement of eligibility, and has
    determined that it is accurate. (Not all of these signatures may
    apply to private schools; write N/A in the space where the position
    or its equivalent is not applicable.)

6.  **Pagination**. Paginate the application and number all pages
    consecutively including the appendices, beginning with the cover
    sheet as page 1, the eligibility requirements as page 2.

7.  **Format**. Narrative answers to questions are generally limited to
    one-half page, approximately 200 words. Do not repeat the
    instructions or include the instructions in the application. It is
    not necessary to repeat the entire question before narrative
    responses; a heading that identifies the response is sufficient. It
    is not necessary to begin each question on a new page. No
    attachments to the application are allowed except for the school
    assessment tables and subgroup norms/standards supplied by
    publishers needed to interpret assessment data. Any other
    attachments will be discarded.

8.  **Submission**. Once they have been invited to apply, all public
    schools send their applications to the U.S. Department of Education
    at the following address:

> J. Stephen O'Brien
>
> *No Child Left Behind -- Blue Ribbon Schools Program*
>
> Office of Intergovernmental and Interagency Affairs
>
> U.S. Department of Education
>
> 400 Maryland Avenue SW, 5E205
>
> Washington, DC 20202-3521

Due to periodic disruptions to normal mail delivery, the Department
strongly encourages the use of a delivery method other than regular mail
(for example, a commercial carrier such as Federal Express or United
Parcel Service; U.S. Postal Service Express mail; or a courier service)
to transmit applications to the Department.

Private schools should consult the CAPE website at
http://www.capenet.org/brs.html

##### U.S. Department of Education September 2003

**2003-2004 *No Child Left Behind---Blue Ribbon Schools Program***

**Cover Sheet**

Name of Principal

(Specify: Ms., Miss, Mrs., Dr., Mr., Other) (As it should appear in the
official records)

Official School Name

(As it should appear in the official records)

School Mailing Address
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(If address is P.O. Box, also include street address)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

City State Zip Code+4 (9 digits total)

Tel. [( )]{.underline} Fax [( )]{.underline}

Website/URL E-mail

I have reviewed the information in this application, including the
eligibility requirements on page 2, and certify that to the best of my
knowledge all information is accurate.

Date\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Principal's Signature)

Name of Superintendent\*

(Specify: Ms., Miss, Mrs., Dr., Mr., Other)

District Name Tel. [( )]{.underline}

I have reviewed the information in this application, including the
eligibility requirements on page 2, and certify that to the best of my
knowledge it is accurate.

Date\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(Superintendent's Signature)

Name of School Board

President/Chairperson

(Specify: Ms., Miss, Mrs., Dr., Mr., Other)

I have reviewed the information in this package, including the
eligibility requirements on page 2, and certify that to the best of my
knowledge it is accurate.

Date\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(School Board President's/Chairperson's Signature)

*\*Private Schools: If the information requested is not applicable,
write N/A in the space.*

**PART I ‑ ELIGIBILITY CERTIFICATION**

**\[Include this page in the school's application as page 2.\]**

The signatures on the first page of this application certify that each
of the statements below concerning the school\'s eligibility and
compliance with U.S. Department of Education, Office of Civil Rights
(OCR) requirements is true and correct.

1.  The school has some configuration that includes grades K-12.
    (Schools with one principal, even K-12 schools, must apply as an
    entire school.)

2.  The school has not been in school improvement status or been
    identified by the state as \"persistently dangerous\" within the
    last two years. To meet final eligibility, the school must meet the
    state's adequate yearly progress requirement in the 2003-2004 school
    year.

3.  If the school includes grades 7 or higher, it has foreign language
    as a part of its core curriculum.

4.  The school has been in existence for five full years, that is, from
    at least September 1998.

5.  The nominated school or district is not refusing the OCR access to
    information necessary to investigate a civil rights complaint or to
    conduct a district‑wide compliance review.

6.  The OCR has not issued a violation letter of findings to the school
    district concluding that the nominated school or the district as a
    whole has violated one or more of the civil rights statutes. A
    violation letter of findings will not be considered outstanding if
    the OCR has accepted a corrective action plan from the district to
    remedy the violation.

7.  The U.S. Department of Justice does not have a pending suit alleging
    that the nominated school, or the school district as a whole, has
    violated one or more of the civil rights statutes or the
    Constitution\'s equal protection clause.

8.  There are no findings of violations of the Individuals with
    Disabilities Education Act in a U.S. Department of Education
    monitoring report that apply to the school or school district in
    question; or if there are such findings, the state or district has
    corrected, or agreed to correct, the findings.

**PART II ‑ DEMOGRAPHIC DATA**

**All data are the most recent year available.**

**DISTRICT** (Questions 1‑2 not applicable to private schools)

1\. Number of schools in the district: \_\_\_\_\_ Elementary schools

\_\_\_\_\_ Middle schools

\_\_\_\_\_ Junior high schools

\_\_\_\_\_ High schools

\_\_\_\_\_ Other (Briefly explain)

\_\_\_\_\_ TOTAL

2\. District Per Pupil Expenditure: \_\_\_\_\_\_\_\_\_\_\_\_\_

Average State Per Pupil Expenditure: \_\_\_\_\_\_\_\_\_\_\_\_\_

**SCHOOL** (To be completed by all schools)

3\. Category that best describes the area where the school is located:

> \[ \] Urban or large central city
>
> \[ \] Suburban school with characteristics typical of an urban area
>
> \[ \] Suburban
>
> \[ \] Small city or town in a rural area
>
> \[ \] Rural

4\. Number of years the principal has been in her/his position at this
school.

If fewer than three years, how long was the previous principal at this
school?

5\. Number of students enrolled at each grade level or its equivalent in
applying school:

  ----------- --------- ----------- ---------- --------- -- ----------- --------- ----------- ---------
  **Grade**   **\# of   **\# of                **Grade      **Grade**   **\# of   **\# of     **Grade
              Males**   Females**              Total**                  Males**   Females**   Total**

  **K**                                                     **7**                             

  **1**                                                     **8**                             

  **2**                                                     **9**                             

  **3**                                                     **10**                            

  **4**                                                     **11**                            

  **5**                                                     **12**                            

  **6**                                                     Other                             

                                    **TOTAL                                                   
                                    STUDENTS                                                  
                                    IN THE                                                    
                                    APPLYING                                                  
                                    SCHOOL →**                                                
  ----------- --------- ----------- ---------- --------- -- ----------- --------- ----------- ---------

6\. Racial/ethnic composition of % White

the students in the school: % Black or African American

\% Hispanic or Latino

\% Asian/Pacific Islander

\% American Indian/Alaskan Native

**100% Total**

7\. Student turnover, or mobility rate, during the past year:
\_\_\_\_\_\_\_\_%

> (This rate includes the total number of students who transferred to or
> from different schools between October 1 and the end of the school
> year, divided by the total number of students in the school as of
> October 1, multiplied by 100.)

  ----------- ---------------------------------- ------------------------
  **(1)**     Number of students who transferred 
              ***to*** the school after October  
              1 until the end of the year.       

  **(2)**     Number of students who transferred 
              ***from*** the school after        
              October 1 until the end of the     
              year.                              

  **(3)**     Subtotal of all transferred        
              students \[sum of rows (1) and     
              (2)\]                              

  **(4)**     Total number of students in the    
              school as of October 1             

  **(5)**     Subtotal in row (3) divided by     
              total in row (4)                   

  **(6)**     Amount in row (5) multiplied by    
              100                                
  ----------- ---------------------------------- ------------------------

8\. Limited English Proficient students in the school: \_\_\_\_\_\_\_%

\_\_\_\_\_\_\_Total Number Limited English Proficient

Number of languages represented: \_\_\_\_\_\_\_\_

Specify languages:

9\. Students eligible for free/reduced-priced meals: \_\_\_\_\_\_\_\_%

\_\_\_\_\_\_\_\_Total Number Students Who Qualify

> If this method does not produce a reasonably accurate estimate of the
> percentage of students from low‑income families or the school does not
> participate in the federally‑supported lunch program, specify a more
> accurate estimate, tell why the school chose it, and explain how it
> arrived at this estimate.

10\. Students receiving special education services: \_\_\_\_\_\_\_\_%

\_\_\_\_\_\_\_\_Total Number of Students Served

> Indicate below the number of students with disabilities according to
> conditions designated in the Individuals with Disabilities Education
> Act.

\_\_\_\_Autism \_\_\_\_Orthopedic Impairment

\_\_\_\_Deafness \_\_\_\_Other Health Impaired

\_\_\_\_Deaf-Blindness \_\_\_\_Specific Learning Disability

\_\_\_\_Hearing Impairment \_\_\_\_Speech or Language Impairment

\_\_\_\_Mental Retardation \_\_\_\_Traumatic Brain Injury

\_\_\_\_Multiple Disabilities \_\_\_\_Visual Impairment Including
Blindness

11. Indicate number of full‑time and part‑time staff members in each of
    the categories below:

    **Number of Staff**

**[Full-time]{.underline}** **[Part-Time]{.underline}**

Administrator(s) \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_

Classroom teachers \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_

Special resource teachers/specialists \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_

Paraprofessionals \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_

> Support staff \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_
>
> Total number \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_

12\. Average school student-"classroom teacher" ratio: \_\_\_\_\_\_\_

13\. Show the attendance patterns of teachers and students as a
percentage. The student dropout rate is defined by the state. The
student drop-off rate is the difference between the number of entering
students and the number of exiting students from the same cohort. (From
the same cohort, subtract the number of exiting students from the number
of entering students; divide that number by the number of entering
students; multiply by 100 to get the percentage drop-off rate.) Briefly
explain in 100 words or fewer any major discrepancy between the dropout
rate and the drop-off rate. (Only middle and high schools need to supply
dropout rates and only high schools need to supply drop-off rates.)

  ------------------------ ----------- ----------- ----------- ----------- -----------
                           2002-2003   2001-2002   2000-2001   1999-2000   1998-1999

  Daily student attendance                                                 

  Daily teacher attendance                                                 

  Teacher turnover rate                                                    

  Student dropout rate                                                     

  Student drop-off rate                                                    
  ------------------------ ----------- ----------- ----------- ----------- -----------

14\. **(*High Schools Only*)** Show what the students who graduated in
Spring 2003 are doing as of September 2003.

+-----------------------------------------------------+----------------+
| Graduating class size                               | > \_\_\_\_\_   |
+-----------------------------------------------------+----------------+
| Enrolled in a 4-year college or university          | > \_\_\_\_\_%  |
+-----------------------------------------------------+----------------+
| Enrolled in a community college                     | > \_\_\_\_\_%  |
+-----------------------------------------------------+----------------+
| Enrolled in vocational training                     | > \_\_\_\_\_%  |
+-----------------------------------------------------+----------------+
| Found employment                                    | > \_\_\_\_\_%  |
+-----------------------------------------------------+----------------+
| Military service                                    | > \_\_\_\_\_%  |
+-----------------------------------------------------+----------------+
| Other (travel, staying home, etc.)                  | > \_\_\_\_\_%  |
+-----------------------------------------------------+----------------+
| Unknown                                             | > \_\_\_\_\_%  |
+-----------------------------------------------------+----------------+
| **Total**                                           | > 100 %        |
+-----------------------------------------------------+----------------+

**PART III ‑ SUMMARY**

Provide a brief, coherent narrative snapshot of the school in one page
(approximately 475 words). Include at least a summary of the school's
mission or vision in the statement.

**PART IV -- INDICATORS OF ACADEMIC SUCCESS**

1.  Describe in one page the meaning of the school's assessment results
    in reading (language arts or English) and mathematics in such a way
    that someone not intimately familiar with the tests can easily
    understand them.

2.  Show in one-half page (approximately 200 words) how the school uses
    assessment data to understand and improve student and school
    performance.

3.  Describe in one-half page how the school communicates student
    performance, including assessment data, to parents, students, and
    the community.

4.  Describe in one-half page how the school will share its successes
    with other schools.

    **PART V -- CURRICULUM AND INSTRUCTION**

```{=html}
<!-- -->
```
1.  Describe in one page the school's curriculum. Outline in several
    sentences the core of each curriculum area and show how all students
    are engaged with significant content based on high standards.
    Include art and foreign languages in the descriptions (foreign
    language instruction as a part of the regular curriculum is an
    eligibility requirement for middle, junior high, high schools, and
    elementary schools in grades seven and higher).

2.  **(Elementary Schools)** Describe in one-half page the school's
    reading curriculum, including a description of why the school chose
    this particular approach to reading.

> **(Secondary Schools)** Describe in one-half page the school's English
> language curriculum, including efforts the school makes to improve the
> reading skills of students who read below grade level.

3.  Describe in one-half page one other curriculum area of the school's
    choice and show how it relates to essential skills and knowledge
    based on the school's mission.

4.  Describe in one-half page the different instructional methods the
    school uses to improve student learning.

5.  Describe in one-half page the school's professional development
    program and its impact on improving student achievement.

**PART VI - PRIVATE SCHOOL ADDENDUM**

*The purpose of this addendum is to obtain additional information from
private schools as noted below. Attach the completed addendum to the end
of the application, before the assessment data tables.*

Private school association(s):

(Give primary religious or independent association only)

Does the school have nonprofit, tax exempt (501(c)(3)) status? Yes
\_\_\_\_\_\_ No \_\_\_\_\_\_

**Part II ‑ Demographics**

1\. What are the 2001-2002 tuition rates, by grade? (Do not include
room, board, or fees.)

\$\_\_\_\_\_\_ \$\_\_\_\_\_\_ \$\_\_\_\_\_\_ \$\_\_\_\_\_\_
\$\_\_\_\_\_\_ \$\_\_\_\_\_\_

K 1^st^ 2^nd^ 3^rd^ 4^th^ 5^th^

\$\_\_\_\_\_\_ \$\_\_\_\_\_\_ \$\_\_\_\_\_\_ \$\_\_\_\_\_\_
\$\_\_\_\_\_\_ \$\_\_\_\_\_\_

6^th^ 7^th^ 8^th^ 9^th^ 10^th^ 11^th^

\$\_\_\_\_\_\_ \$\_\_\_\_\_\_

12^th^ Other

2\. What is the educational cost per student? \$\_\_\_\_\_\_

(School budget divided by enrollment)

3\. What is the average financial aid per student? \$\_\_\_\_\_\_

4\. What percentage of the annual budget is devoted to \_\_\_\_\_\_%

scholarship assistance and/or tuition reduction?

5\. What percentage of the student body receives

scholarship assistance, including tuition reduction? \_\_\_\_\_\_%

**PART VII - ASSESSMENT RESULTS**

> **Public Schools**
>
> In a letter to the U.S. Secretary of Education accompanying the list
> of nominated schools, the CSSO of each state certifies that the
> schools have all met the minimum requirements established by the CSSO
> for "dramatically improved" and achieving at "high levels" or for
> being in the top 10 percent of schools in the state. The letter from
> the CSSO to the Secretary explains the criteria used by the state to
> nominate the schools. States must rely on the state accountability
> system to identify schools for submission to the Secretary.
>
> Based on state data, the CSSO certifies that the submitted schools
> meet one of two criteria: 1) dramatic improvement in test scores to
> high levels in the past three years in reading (language arts or
> English) and mathematics for schools that draw at least 40 percent of
> their students from disadvantaged backgrounds, or 2) regardless of a
> school's demographics, achievement in the top 10 percent of schools in
> the state as measured by state tests of reading (language arts or
> English) and mathematics or in the top 10 percent in the state on
> assessments referenced against national norms in at least the last
> grade tested.
>
> "Dramatically improved" is defined by the CSSO of each state based on
> the state's definition of adequate yearly progress (AYP). All student
> groups, including disadvantaged students, must show dramatic
> improvement as shown by disaggregated data. "High levels" is defined
> by the CSSO of each state, but at a minimum includes student
> achievement at least at the 55th percentile on state assessments in
> the highest grade tested even if the school makes AYP.
>
> A student from a "disadvantaged background" is defined as one who is
> eligible for free or reduced-priced meals at the school, is limited
> English proficient, is a migrant student, or is a student receiving
> services under Title I of the Elementary and Secondary Education Act,
> as amended by the No Child Left Behind Act of 2001.
>
> Each nominated school must show results in reading (language arts or
> English) and mathematics for at least the last three years using the
> criteria determined by the CSSO using the state accountability system.
> If the state uses only assessments referenced against national norms
> at a particular grade, the school should explain how these tests
> measure the depth and breadth of the state's academic content
> standards. For formatting, if possible use or adapt the sample tables
> (no charts or graphs) at the end of this application.
>
> If the state allows the use of the PSAT, PLAN, SAT, or ACT as part of
> its accountability system, at least 90 percent of the students in the
> appropriate classes must take the tests. For these tests, schools must
> use national norms. The national school norms for the 90^th^ and
> 55^th^ percentiles can be found on the U.S. Department of Education's
> Web site. If fewer than 90 percent take a particular test, do not
> report the data. If the PSAT, PLAN, SAT, or ACT are not an official
> part of the state accountability system, schools should not report the
> data.
>
> The school must disaggregate the data for socioeconomic groups that
> comprise sufficient numbers to be a part of the state's assessment
> reports. If it is not possible to disaggregate by socioeconomic level,
> the school should disaggregate by ethnic/racial groups if they
> comprise sufficient numbers to be statistically significant. Show how
> all subgroups of students achieved at high levels or improved
> dramatically in achievement for at least three years. Explain any
> disparity among subgroups.
>
> The school must specify which groups, if any, are excluded from a
> test, the reasons for the exclusion, as well as the number and
> percentage of students excluded. Describe how these students are
> assessed and attach all tables that show test data to the end of this
> application. Continue to number the pages consecutively.
>
> **Private Schools**
>
> A private school may be recognized as a *No Child Left Behind -- Blue
> Ribbon School* in two ways. First, a school can be recognized if it
> has at least 40 percent of its students from disadvantaged backgrounds
> who have dramatically improved their performance in at least the past
> three years in reading (language arts or English) and mathematics, and
> are achieving at high levels.
>
> A student from a "disadvantaged background" is defined as one who is
> eligible for free or reduced-priced meals at the school, is limited
> English proficient, is a migrant student, or is a student receiving
> services under Title I of the Elementary and Secondary Education Act,
> as amended by the No Child Left Behind Act of 2001. "Dramatically
> improved" is defined as an increase of at least one-half standard
> deviation over at least three years and includes the disadvantaged
> students as shown by disaggregated data. "High levels" is defined as
> student achievement in at least the last grade tested at or above the
> 55^th^ percentile (5 percentage points above the mean) on assessments
> referenced against national norms at a particular grade, or at or
> above the 55^th^ percentile on state tests.
>
> Second, regardless of the school's demographics, it may be recognized
> if its students achieve at the highest levels, that is, if the school
> is in the top 10 percent of the schools in the nation in reading
> (language arts or English) and mathematics in the last grade tested,
> as measured by an assessment referenced against national norms or in
> the top 10 percent in its state as measured by a state test in at
> least the last grade tested.
>
> Report the school's assessment results in reading (language arts or
> English) and mathematics for at least the last three years for all
> grades tested on state tests or assessments referenced against
> national norms. For formatting, use or adapt the sample tables (no
> charts or graphs) at the end of this application. Present data for all
> grades tested for all standardized state assessments or, if the school
> does not administer state tests, for assessments referenced against
> national norms administered by the school.
>
> If at least 90 percent of the students take the PSAT, PLAN, SAT, or
> ACT, high schools should include the data, unless students take state
> assessments. In the case where all private secondary school students
> participate in state assessments, do not report the data from the
> PSAT, PLAN, SAT, or ACT.
>
> The school must disaggregate the data for students eligible for free
> or reduced-priced meals if that cohort of students comprises 10
> percent or more of the student body of the school. The school must
> disaggregate the data whether or not the school actually offers the
> federal school lunch program. If the school does not collect family
> income data and cannot disaggregate by socioeconomic level, the school
> should disaggregate by ethnic/racial groups that comprise 10 percent
> or more of the student body of the school. Show how all subgroups of
> students achieved at high levels or improved dramatically in
> achievement for at least three years. Explain any disparity among
> subgroups.
>
> The school must specify which groups, if any, are excluded from a
> test, the reasons for the exclusion, as well as the number and
> percentage of students excluded. Describe how these students are
> assessed and attach all tables that show test data to the end of this
> application. Continue to number the pages consecutively.
>
> **SAMPLE FORMAT FOR STATE CRITERION-REFERENCED TESTS**
>
> The sample Data Display Table is illustrated on the following page.
>
> Change the sample table to fit the state's assessment system.
>
> Provide the following information for all tests in reading (language
> arts or English) and mathematics. Complete a separate form for reading
> (language arts or English) and mathematics at each grade level.
>
> Grade\_\_\_\_\_\_\_\_
>
> Test\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Edition/publication year\_\_\_\_\_\_\_\_ Publisher
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Number of students in the grade in which the test was administered
> \_\_\_\_\_\_\_
>
> Number of students who took the test \_\_\_\_\_\_\_

What groups were excluded from testing? Why, and how were they assessed?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Number excluded\_\_\_\_\_\_\_\_ Percent excluded\_\_\_\_\_\_\_\_
>
> For the school and state, report scores as the percentage of students
> tested whose performance was scored at or above the cutpoint used by
> the state for 1) basic, 2) proficient, and 3) advanced, or similar
> categories as defined by the state. States will vary in their
> terminology and cutpoints. If the state does not report scores using
> the categories of basic, proficient, and advanced, use the state's
> categories and report data for each category. Note that the reported
> percentage of students scoring above the basic cutpoint should include
> students scoring above the proficient and advanced cutpoints. For
> example, 100% of students are at "basic," 69% are at "proficient," and
> 42% are at "advanced."
>
> Explain the standards for basic, proficient, and advanced (or the
> relevant state categories), and make clear what the test results mean
> in a way that someone unfamiliar with the test can interpret the
> results.
>
> **SAMPLE FORMAT FOR STATE CRITERION-REFERENCED TESTS, Continued**
>
> Sample Data Display Table for Reading (language arts or English) and
> Mathematics

  ------------------------------------------------------ ----------- ----------- ----------- ----------- -----------
                                                         2002-2003   2001-2002   2000-2001   1999-2000   1998-1999

  Testing month                                                                                          

  **SCHOOL SCORES**                                                                                      

  \% At or Above Basic                                                                                   

  \% At or Above Proficient                                                                              

  \% At Advanced                                                                                         

  Number of students tested                                                                              

  Percent of total students tested                                                                       

  Number of students excluded                                                                            

  Percent of students excluded                                                                           

                                                                                                         

  SUBGROUP SCORES                                                                                        

  1.\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (specify                                                  
  subgroup)                                                                                              

  \% At or Above Basic                                                                                   

  \% At or Above Proficient                                                                              

  \% At Advanced                                                                                         

  Number of students tested                                                                              

  2.\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(specify                                                   
  subgroup)                                                                                              

  \% At or Above Basic                                                                                   

  \% At or Above Proficient                                                                              

  \% At Advanced                                                                                         

  Number of students tested                                                                              

                                                                                                         

  **STATE SCORES**                                                                                       

  \% At or Above Basic                                                                                   

  State Mean Score                                                                                       

  \% At or Above Proficient                                                                              

  State Mean Score                                                                                       

  \% At Advanced                                                                                         

  State Mean Score                                                                                       
  ------------------------------------------------------ ----------- ----------- ----------- ----------- -----------

Use the same basic format for subgroup results. Complete a separate form
for each test and each grade level. Present *at least* three years of
data to show decreasing disparity among subgroups. Some subgroup
examples are:

(a) Socioeconomic Status (e.g., eligible for free and reduced meals, not
    eligible for free and reduced meals)

> \(b\) Ethnicity (e.g., White, Black or African American, Hispanic or
> Latino, Asian/Pacific Islander, American Indian/Alaskan Native)

**[SAMPLE FORMAT FOR DISPLAYING ASSESSMENTS]{.underline}**

**[REFERENCED AGAINST NATIONAL NORMS]{.underline}**

Provide the following information for all tests in reading (language
arts or English) and mathematics. Show at least three years of data.
Complete a separate form for each test and grade level, and place it on
a separate page.

Grade\_\_\_\_\_\_\_\_
Test\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Edition/publication year\_\_\_\_\_\_\_\_ Publisher
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Number of students in the grade in which the test was administered
\_\_\_\_\_\_\_

Number of students who took the test \_\_\_\_\_\_\_

What groups were excluded from testing? Why, and how were they assessed?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Scores are reported here as (check one): NCEs\_\_\_\_ Scaled scores
\_\_\_\_ Percentiles\_\_\_\_

  ------------------------------------------ -- ----------- -- ----------- -- ----------- -- ----------- -- -----------
                                                2002-2003      2001-2002      2000-2001      1999-2000      1998-1999

  Testing month                                                                                             

  **SCHOOL SCORES**                                                                                         

  Total Score                                                                                               

  Number of students tested                                                                                 

  Percent of total students tested                                                                          

  Number of students excluded                                                                               

  Percent of students excluded                                                                              

  SUBGROUP SCORES                                                                                           

  1.\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                                                  
  (specify subgroup)                                                                                        

  Number of students tested                                                                                 

  2.\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                                                  
  (specify subgroup)                                                                                        

  Number of students tested                                                                                 

  3.\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                                                  
  (specify subgroup)                                                                                        

  Number of students tested                                                                                 

  4.\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                                                  
  (specify subgroup)                                                                                        

  Number of students tested                                                                                 
  ------------------------------------------ -- ----------- -- ----------- -- ----------- -- ----------- -- -----------

If the reports use scaled scores, provide the national score (mean
score) and standard deviation for the total test and each subtest.

  ------------------------------ ----------- ----------- ----------- ----------- -----------
                                 2002-2003   2001-2002   2000-2001   1999-2000   1998-1999

  **NATIONAL MEAN SCORE**                                                        

  **NATIONAL STANDARD                                                            
  DEVIATION**                                                                    
  ------------------------------ ----------- ----------- ----------- ----------- -----------