REQUIREMENTS AND DOCUMENT SUBMISSION INSTRUCTIONS When completing the Request for Waiver Form, please check all boxes that apply. To be considered, the Request for Waiver Form must be accompanied by documentation for items 1-11, as listed below. If a Waiver Pending ESD Certification is requested, please see Item 11 below. Copies of the following information and all relevant supporting documentation must be submitted along with the request. 1. A statement setting forth your basis for requesting a partial or total waiver. 2. The names of general circulation, trade association, and M/WBE-oriented publications in which you solicited certified M/WBEs for the purposes of complying with your participation goals. 3. A list identifying the date(s) that all solicitations for certified M/WBE participation were published in any of the above publications. 4. A list of all certified M/WBEs appearing in the NYS Directory of Certified Firms that were solicited for purposes of complying with your certified M/WBE participation levels. 5. Copies of notices, dates of contact, letters, and other correspondence as proof that solicitations were made in writing and copies of such solicitations, or a sample copy of the solicitation if an identical solicitation was made to all certified M/WBEs. 6. Provide copies of responses made by certified M/WBEs to your solicitations. 7. Provide a description of any contract documents, or specifications made available to certified M/WBEs for purposes of soliciting their bids and the date and manner in which these documents were made available. 8. Provide documentation of any negotiations between you, the Bidder/Applicant and the M/WBEs undertaken for purposes of complying with the certified M/WBE participations goals. 9. Provide any information you deem relevant which may help us in evaluating your request for a waiver. 10. Provide the name, title, address, telephone number and email address of the Bidder/Applicant's representative authorized to discuss and negotiate this waiver request. 11. Copy of notice of application receipt issued by Empire State Development (ESD). NOTE: Unless a Total Waiver has been granted, Bidder/Applicant will be required to submit all reports and documents pursuant to the provisions set forth in the procurement and/or contract, as deemed appropriate by NYSED, to determine M/WBE compliance.
Not Found (N/F) - Does not address the criteria or simply restates the criteria. Executive Summary (0 points) The proposal briefly and concisely describes the purpose and goals of the project and how the goals will be accomplished. Excellent Good Fair Poor N/F Comments: Organizational Background (36 points) The proposal provides an overview and brief description of the applicant school, district, and administrative structure Excellent Good Fair Poor N/F 4 3 2 1 0 The proposal identifies the process used by the applicant to secure institutions of higher education (IHE); and community based programs (CBP) as partners in identifying school models 2 1.5 1 .5 0 Applicant’s partner for demonstration and replication must be a school within another district within the applicant’s region, a school receiving American Indian Educational Services, NYC, or rest of state, that is a struggling or persistently struggling school and the partner must be identified in the application. Where no demographically similar struggling or persistently 4 3 2 1 0