COVER PAGE School Application for Waiver from Commissioner’s Regulations Section 100.19(k)(3)(i)

District Name
District Address
Receivership School Name
School Address
School Accountability Status
Receivership Status: Persistently Struggling or Struggling
Name of Person Completing Form
Title of Person Completing Form
Address of Person Completing Form
Telephone Number
Email Address:
Superintendent of Schools Name
Superintendent of Schools Signature
Date Board of Education Approved Request for Waiver
Date BoE Submitted Request for Waiver to NYSED for Approval
Date NYSED approved Request for Waiver

CR §100.19 (k)(3)(i) Requirement:

Commissioner’s Regulations Section 100.19 (k)(3)(i) states that Community Schools Grant funds must be used to support the operating and capital costs associated with the transformation of designated schools into community hubs to deliver co-located or school-linked academic, health, mental health, nutrition, counseling, legal, and/or other services to students and their families, which may include, but need not be limited to, the following:

providing a community school site coordinator at each Struggling or Persistently Struggling school receiving a grant as per CR §100.19. The school district shall designate a full-time staff person to serve as the community school site coordinator at each such school who shall assist the school receiver in implementing the grant including, but not limited to, managing the development of the community school strategy for that school; coordinating and integrating service delivery at the school; ensuring the maintenance and sustainability of the community school; and consulting and coordinating with any other community school site coordinators, if applicable. If there are circumstances that do not justify the assignment of a full-time staff person to serve as the community school coordinator for each school (e.g., the designated school is a small school and a full-time coordinator is not needed), or if the designation of one full-time site coordinator for multiple schools would be more effective (e.g., if the two schools designated in the district are small schools in close proximity and a full-time coordinator could serve both schools), the school may apply to the Commissioner for a waiver from this requirement.

School Request:

The _______________________________________ (Receivership school) requests consideration of the application for a waiver from Commissioner’s Regulations Section 100.19 (k)(3)(i). Unless otherwise stated, the requested time period and effective date of this waiver is the Community Schools Grant fund dates of August 1, 2017 to June 30, 2018. The application has been completed in accordance with the accompanying instructions in developing the waiver request.

Application Narrative:

By requesting this waiver, the school indicates that it will not have a school district designated full-time staff person to serve as its community school site coordinator. The school is requesting that the Commissioner approve an alternative arrangement to this requirement and needs to provide evidence that “circumstances do not justify the school district designating a full-time staff person to serve as the community school site coordinator at each Receivership school.”

Please provide such evidence by responding to the following questions:

Discuss the specific circumstances that do not justify the school district designating a full-time staff person to serve as your community school site coordinator.

Describe the alternative arrangement the school will have with a community school site coordinator (sharing with another school, part-time, etc.).

Describe how this alternative arrangement will allow for the implementation of the Community School Grant in these areas:

managing the development of the community school strategy for that school; and

coordinating and integrating service delivery at the school; and

ensuring the maintenance and sustainability of the community school; and

consulting and coordinating with any other community school site coordinators.

Describe the measures to be used to assess the effectiveness of this alternative arrangement with the implementation of this grant.

Email a complete signed application to OISR@nysed.gov with the subject line: CSG Waiver. Do not mail a hard copy. Your OISR district liaison will review the waiver in conjunction with the information provided in your Community Schools Grant Application. NYSED will contact you if additional clarification is needed prior to the approval/disapproval of the request.