Authority: IC 20-19-2-8

Affected: IC 20-26-5-1; IC 20-30

Sec. 4. The waiver application shall contain:

1. (1) the name and address of the school corporation, non-public school or group of non-public schools requesting the waiver;
2. (2) the name and address of the school(s) in which the proposed course or curriculum program will be implemented;
3. (3) the name, address and phone number of the local contact person most knowledgeable about the proposal;
4. (4) the grade level(s) and approximate number of the students who will participate;
5. (5) the identification of the rules sections for which waivers are being requested;
6. (6) the beginning date for the planned implementation; the duration of the proposed waiver period; and in the case of an extension or an amendment of a previously approved waiver, the date of the last application;
7. (7) in the case of a high school course or program, the number of credits to be awarded;
8. (8) the signature of the superintendent;

9. (9) a narrative description of the proposed course or curriculum program including:

   1. (A) Rationale–A statement of purpose, including how the proposed course or curriculum program will more effectively serve the needs of the students.
   2. (B) Instructional objectives–Statements of the kinds of learning that will result from the implementation of the program.
   3. (C) Course or program description–A summary of the content and educational activities to be included in the proposed course or curriculum program.
   4. (D) Instructional materials–Identification and/or description of the basal instructional materials to be used.
   5. (E) Staffing–A statement of the qualifications of staff members who will implement the program and/or the training which will be provided the implementation staff.

   6. (F) Evaluation–A description of how:

      1. (i) student progress in the program will be evaluated, and
      2. (ii) the effectiveness of the program will be evaluated.
   7. (G) Contracts–A description of any special contracts which the governing body will have to execute in order to implement the proposal.
   8. (H) Resources–A statement of what local, state, federal or other funds will be used to support the proposed course or program, as well as a description of other available or needed resources and facilities.
   9. (I) Planning–A description of the planning process, including the extent of community and staff involvement.

(Indiana State Board of Education; 511 IAC 6-8-4; filed Sep 13, 1984, 10:09 am: 8 IR 71; readopted filed Oct 12, 2001, 12:55 p.m.: 25 IR 937; readopted filed Nov 20, 2007, 11:36 a.m.: 20071219-IR-511070386RFA; readopted filed Nov 4, 2009, 12:03 p.m.: 20091202-IR-511090701RFA; readopted filed Sep 23, 2015, 12:13 p.m.: 20151021-IR-511150257RFA; readopted filed Nov 17, 2021, 8:25 a.m.: 20211215-IR-511210429RFA; readopted filed Nov 21, 2025, 11:47 a.m.: 20251210-IR-511240639RFA) NOTE: Agency cited as 510 IAC 4-6-4, which was renumbered by legislative services agency as 511 IAC 6-8-4.