6:160-E4 Refusal of English Language Learner (ELL) Services

I, ___________________________, the parent/guardian of ___________________________, a student at ________________, hereby acknowledge the following:

1. I understand that the school’s recommendation for the best instructional placement for my child is that s/he be placed in her/his school’s ELL program.

2. I understand the reasons for the recommendation referenced above. The possible positive and negative outcomes of enrolling my child in ELL at this time have been explained to me.

3. I agree to take responsibility for any future negative impact this decision might have on my child’s education. 4. I understand that my student must participate in any state mandated assessments, as appropriate.

Therefore, I request that my child not receive ELL instruction.

____________________________               ____________________

Parent/guardian                                              Date

Date Approved: April 10, 2007