TEXAS EDUCATION AGENCY
DEPARTMENT FOR THE EDUCATION 
OF SPECIAL POPULATIONS			
District Name				County-District No.	

					
District Address					

REQUEST FOR MAXIMUM CLASS SIZE WAIVER *

Authority for Data Collection: TEC §25.112
Planned Use of Data: Exception from class size limit in kindergarten through grade four.
Instructions:  This request for a temporary waiver of compliance with requirements for maximum class size in kindergarten through grade four is valid for ONLY ONE SEMESTER.  See enclosed instructions for submission of district compliance plan.  For further information concerning class size waivers, contact the Waiver Unit in the Department for the Education of Special Populations at (512) 463-9630.

Part I.  For the district as a whole:

A.	Complete this table: 

Grade	K	1	2	3	4
Waiver Requested
(Check all that apply)
Total No. of Classes 
Exceeding 22:1 in the
District
No. of Bilingual/ESL
Classes Exceeding 22:1 
in the District
Total Classes (including
Bilingual/ESL) in the 
District

B.	A copy of the current compliance plan for this semester must accompany this application.

C.	Complete the information/certification below:

Name of Superintendent (Typed)		Date of	Signature
Signature

Name of Board President (Typed) 	Date of	Signature
Board 
Approval

Name of District Contact Person	Telephone	Facsimile

								* It is not necessary to submit this form unless a waiver is needed.

Return to:
	Texas Education Agency
	Department for the Education of Special Populations
	Waiver Unit
	1701 North Congress
	Austin, TX  78701
SP-001R990825

		TEXAS EDUCATION AGENCY
DEPARTMENT FOR THE EDUCATION 
OF SPECIAL POPULATIONS			
District Name				County-District No.	

REQUEST FOR MAXIMUM CLASS SIZE WAIVER, con't.

Part II.  For each campus for which a waiver is requested, indicate the following:

A.	Campus Name: __________________________________________   Campus Number  ___________

B.	Complete this table:

Grade	K	1	2	3	4
Waiver Requested
(Check all that apply)
Total No. of Classes 
Exceeding 22:1 on the 
Campus
No. of Bilingual/ESL
Classes Exceeding 22:1
on the Campus
Total Classes (including
Bilingual/ESL) on the 
Campus

C.	Reason(s) for request:	________ Facilities
	(Check all that apply)	________ Teacher(s)
		________ Unanticipated enrollment growth requires up to 23 or 
					   24 pupils in no more than one class per grade, K-4.

D.	This waiver is for the  Fall OR  Spring semester of the 19_______-________ school year.
E.	The district's expected date of compliance for this campus is _________________.

SP-001R990825