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**2004-2005**

***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

**2004-2005 *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.*

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 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. Second, it recognizes
schools, regardless of their demographics, that are in the top 10
percent of schools as measured by state tests of reading (language arts
or English) and mathematics or that score in the top 10 percent 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* are honored at a
Washington, DC ceremony. In addition, the winning applications are
posted on the U.S. Department of Education's (Department) website 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
Chief State School Officer (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 that meet the
criteria for recognition.

The CSSO must insure that the schools meet the criteria for recognition
before submitting their names. In a letter to the Department
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 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. 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 nominated schools meet
one of two criteria:

1)  The school shows dramatic improvement in test scores to high levels
    in at least 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.

> "*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 60th percentile of schools in the school's
> grade category (elementary, middle, high school) on state assessments
> in the highest grade tested in the last year 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.

2)  Regardless of the its demographics, the school achieves in the top
    10 percent of schools in the state in the school's grade category as
    measured by state tests of reading (language arts or English) and
    mathematics in at least the last grade tested in the last year
    tested.

At least one-third of the schools nominated by each state must have in
the year the school applies 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 nominates seven schools, 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 receives the nominations from the CSSO, the
Department invites the nominated schools to submit applications for
possible recognition as a *No Child Left Behind -- Blue Ribbon School.*

The following table demonstrates the type of schools the Secretary
wishes the CSSO to identify. In Table 1, the reading scores of the *No
Child Left Behind -- Blue Ribbon 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 in their grade level category.
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.

**Table 1**

***No Child Left Behind - Blue Ribbon School***

**Grade 5 Reading (sample data)**

# State Tests

  ----------------------------------- ----------- ----------- ----------- ----------- -----------
                                      2003-2004   2002-2003   2001-2002   2000-2001   1999-2000

  Testing month                       May         May         May         May         May

  **SCHOOL SCORES**                                                                   

  \% At or Above Basic                98          90          83          74          62

  %At or Above Proficient             50          49          44          41          37

  %At Advanced                        34          27          19          15          16

                                                                                      

  Number of students tested           110         113         115         111         105

  Percent of total students tested    100         100         100         100         100

  Number of students alternatively    0           0           0           0           0
  assessed                                                                            

  Percent of students alternatively   0           0           0           0           0
  assessed                                                                            

  SUBGROUP SCORES                                                                     

  1\. Economically Disadvantaged                                                      

  %At or Above Basic                  90          81          68          55          41

  %At or Above Proficient             44          36          33          22          14

  %At Advanced                        26          23          22          16          9

  Number of Students Tested           53          58          56          55          50

  2\. Black                                                                           

  %At or Above Basic                  93          87          79          71          60

  %At or Above Proficient             50          47          41          38          29

  %At Advanced                        32          26          18          15          14

  Number of Students Tested           30          31          34          32          29

  3\. White                                                                           

  %At or Above Basic                  98          92          87          76          64

  %At or Above Proficient             51          48          46          41          38

  %At Advanced                        35          29          20          15          17

  Number of Students Tested           50          51          53          51          50

  4\. Hispanic                                                                        

  %At or Above Basic                  90          80          69          56          40

  %At or Above Proficient             44          32          29          21          13

  %At Advanced                        23          19          15          10          6

  Number of Students Tested           30          31          28          28          26

  **STATE SCORES**                                                                    

  %At or Above Basic                  75          68          61          52          47

  %At or Above Proficient             31          31          24          21          16

  %At Advanced                        16          11          9           6           2
  ----------------------------------- ----------- ----------- ----------- ----------- -----------

**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 private schools. In submitting the
applications, CAPE certifies that the schools meet the criteria for
recognition.

A private school may be recognized as a *No Child Left Behind -- Blue
Ribbon School* in two ways.

1.  A school 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 in the last year
> tested at or above the 60th percentile of schools on assessments
> referenced against national norms at a particular grade, or at or
> above the 60th percentile of schools on state tests. If a private
> school administers state tests and nationally normed tests, the school
> must be at or above the 60th percentile in both.

2.  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. If a private school administers state
    tests and nationally normed tests, the school must be in the top 10
    percent in both.

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 the District of
Columbia, Puerto Rico, the Bureau of Indian Affairs Schools (BIA), and
the Department of Defense Education Agency (DoDEA), 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 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.
The BIA and DoDEA may nominate one school each. CAPE may nominate 50
private schools. The potential total for all nominations is 415.

Eligible schools, then, are those nominated by the CSSO or CAPE that
meet the eligibility requirements listed on page 9 of this application,
meet the assessment criteria 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
Department 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 2004-2005**

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 8: Responses are due from the CSSO to the Secretary.

November 22: The Department sends letters of invitation with
applications to the schools recommended by the CSSO.

February 10: Completed applications are due to the Department.

September The Secretary announces the 2005 *No Child Left Behind -- Blue
Ribbon Schools.*

Fall 2005 A Washington, DC ceremony honors the schools.

**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 one original copy with signatures on
    the completed application. The signed original application must be
    stapled in the upper left-hand corner and should be printed on one
    side. 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**. At the same time as the paper copy, the school
    also submits the entire application electronically in one file by
    sending it as an attachment (including the cover sheet and data
    tables). The electronic version should not contain signatures. The
    file must be written in Microsoft Word in PC format. Word and PDF
    versions of the blank application are on the Department's website.
    The electronic copy should be sent to
    [nclbbrs@rmcres.com]{.underline} with a copy to the school's state
    contact. The purpose of this address is solely for receiving
    applications; questions should not be sent there.

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 300 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. Any other attachments will be discarded.

8.  **Public School 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 first
> class 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.

9.  **Private School Submission.**

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

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

**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.

##### *2004-2005 No Child Left Behind - Blue Ribbon Schools Program*

*U.S. Department of Education*

**Cover Sheet** Type of School: \_\_ Elementary \_\_ Middle \_\_ High
\_\_ K-12

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)

County
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_School
Code Number\*\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Telephone [( )]{.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 2004-2005 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 1999 and has not received the 2003 or 2004 *No
    Child Left Behind -- Blue Ribbon Schools Award.*

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

\_\_\_\_\_ 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 as of October 1 enrolled at each grade level or
its equivalent in applying school only:

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

  **PreK**                                                  **7**                             

  **K**                                                     **8**                             

  **1**                                                     **9**                             

  **2**                                                     **10**                            

  **3**                                                     **11**                            

  **4**                                                     **12**                            

  **5**                                                     **Other**                         

  **6**                                                                                       

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

*\[Throughout the document, round numbers to avoid decimals.\]*

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**

Use only the five standard categories in reporting the racial/ethnic
composition of the school.

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

> (This rate should be calculated using the grid below. The answer to
> (6) is the mobility rate.)

  --------- -------------------------------------------- ------------------
  **(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 an 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

\_\_\_\_Emotional Disturbance \_\_\_\_Speech or Language Impairment

\_\_\_\_Hearing Impairment \_\_\_\_Traumatic Brain Injury

> \_\_\_\_Mental Retardation \_\_\_\_Visual Impairment Including
> Blindness

\_\_\_\_Multiple Disabilities

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.)

  -------------------------- ----------- ----------- ----------- ----------- -----------
                             2003-2004   2002-2003   2001-2002   2000-2001   1999-2000

  Daily student attendance   \%          \%          \%          \%          \%

  Daily teacher attendance   \%          \%          \%          \%          \%

  Teacher turnover rate      \%          \%          \%          \%          \%

  Student dropout rate       \%          \%          \%          \%          \%
  (middle/high)                                                              

  Student drop-off rate      \%          \%          \%          \%          \%
  (high school)                                                              
  -------------------------- ----------- ----------- ----------- ----------- -----------

14\. **(*High Schools Only*)** Show what the students who graduated in
Spring 2004 are doing as of September 2004.

+---------------------------------------------------------+------------+
| 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 600 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. Explain disparities among subgroups. If the school
    participates in the state assessment system, briefly explain the
    state performance levels and the performance level that demonstrates
    meeting the standard. Provide the website where information on the
    state assessment system may be found.

2.  Show in one-half page (approximately 300 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 has shared and will
    continue to share its successes with other schools.

    **PART V -- CURRICULUM AND INSTRUCTION**

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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 core curriculum is an
    eligibility requirement in grades seven and higher).

2a. **(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.

2b. **(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.*

1.  Private school association(s):

> (Identify the religious or independent associations, if any, to which
> the school belongs. List the primary association first.)

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

3.  What are the 2004-2005 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

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

(School budget divided by enrollment)

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

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

scholarship assistance and/or tuition reduction?

7.  What percentage of the student body receives

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

**PART VII - ASSESSMENT RESULTS**

**Public Schools**

Each nominated school must show results in reading (language arts or
English) and mathematics for at least the last three years according to
the criteria used by the CSSO to nominate the school. 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 and at least 90 percent of the students in the
appropriate classes must take the tests, schools must report the
results. For these tests, schools must use national norms. The national
school norms for the 90th and 60th percentiles can be found on the
Department's website. If fewer than 90 percent of the students take a
combination of the tests, that is, the ACT and the SAT or the PLAN and
the PSAT, do not report the data.

The school must disaggregate all data for socioeconomic and
ethnic/racial groups that comprise sufficient numbers to be a part of
the state's assessment reports or are of 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 the number and percentage of students assessed by alternative
methods.

All test data tables should be attached to the end of the application,
with all pages numbered consecutively.

**Private Schools**

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 and 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 report the data.

The school must disaggregate the data for students eligible for free or
reduced-priced meals and for ethnic/racial groups if a specific group
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. 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 the number and percentage of students assessed
by alternative methods. 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**

\[*Sample Data Display Table for Reading (language arts or English) and
Mathematics*\]

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

Edition/Publication Year\_\_\_\_\_\_\_\_
Publisher\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  ------------------------------------------------------ ----------- ----------- ----------- ----------- -----------
                                                         2003-2004   2002-2003   2001-2002   2000-2001   1999-2000

  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 alternatively assessed                                                              

  Percent of students alternatively assessed                                                             

                                                                                                         

  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                                                                                   

  \% At or Above Proficient                                                                              

  \% At Advanced                                                                                         
  ------------------------------------------------------ ----------- ----------- ----------- ----------- -----------

Provide information in a table similar to the one above for all tests in
reading (language arts or English) and mathematics. Complete a separate
table for reading (language arts or English) and mathematics at each
grade. **Change the sample table to use the state assessment system's
categories and terminology.** Explain any alternative assessments. See
the sample table on page 4.

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 example, 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 all levels. **Note that the reported
percentage of students scoring above the basic cutpoint should be
cumulative** and include students scoring at or above the proficient
level and at the advanced level. For example, 100% of students are at
"basic," 69% are at "proficient," and 42% are at "advanced."

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 \[e.g., eligible for free and
reduced-priced meals, not eligible for free and reduced-priced meals\];
(b) Ethnicity \[e.g., White, Black or African American, Hispanic or
Latino, Asian/Pacific Islander, American Indian/Alaskan Native\]; (c)
Students with Disabilities.

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

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

\[*Sample Data Display Table for Reading (language arts or English) and
Mathematics*\]

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 table for each test and grade level, and place it on
a separate page. Explain any alternative assessments.

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

Edition/Publication Year\_\_\_\_\_\_\_\_
Publisher\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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

+---------------------------------+------+------+------+------+------+
|                                 | 2    | 2    | 2    | 2    | 1    |
|                                 | 003- | 002- | 001- | 000- | 999- |
|                                 | 2004 | 2003 | 2002 | 2001 | 2000 |
+---------------------------------+------+------+------+------+------+
| > Testing month                 |      |      |      |      |      |
+---------------------------------+------+------+------+------+------+
| > **SCHOOL SCORES**             |      |      |      |      |      |
+---------------------------------+------+------+------+------+------+
| > Total Score                   |      |      |      |      |      |
+---------------------------------+------+------+------+------+------+
| > Number of students tested     |      |      |      |      |      |
+---------------------------------+------+------+------+------+------+
| > Percent of total students     |      |      |      |      |      |
| > tested                        |      |      |      |      |      |
+---------------------------------+------+------+------+------+------+
| > Number of students            |      |      |      |      |      |
| > alternatively assessed        |      |      |      |      |      |
+---------------------------------+------+------+------+------+------+
| > Percent of students           |      |      |      |      |      |
| > alternatively assessed        |      |      |      |      |      |
+---------------------------------+------+------+------+------+------+
| > 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 mean score and
> standard deviation for the test.

  -------------------------------- ----------- ----------- ----------- ----------- -----------
                                   2003-2004   2002-2003   2001-2002   2000-2001   1999-2000

  **NATIONAL MEAN SCORE**                                                          

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