Wisconsin Department of Public Instruction INSTRUCTIONS: ARRA waiver requests must be received and
TITLE I, PART A / ARRA WAIVER approved before the LEA’s Title I-ARRA application can be
approved. Submit completed form to:
PER PUPIL AMOUNT FOR SUPPLEMENTAL
EDUCATIONAL SERVICES (SES) WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION
DPI-0009 (New 10-09) TITLE I AND SCHOOL SUPPORT TEAM
ATTN: MARCIA MEYERS
P.O. BOX 7841
School Year 2009-2010 MADISON, WI 53707-7841
FUNDS UNDER TITLE I, PART A OF THE ELEMENTARY AND SECONDARY EDUCATION ACT OF 1965
MADE AVAILABLE UNDER
THE AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009 (ARRA)
This waiver affects the amount the LEA must spend for each student receiving SES. This waiver permits its LEAs to exclude some or all of their Title
I, Part A ARRA funds in calculating the per-pupil amount for SES. Section 1116(e)(6)(A) of the ESEA and in 34 CFR § 200.48(c)(1).
The LEA will comply with all of the statutory and regulatory requirements regarding the provisions of SES with respect to its regular FY 2009
Title I, Part A allocation; and
The LEA will comply with all other title I, Part A statutory and regulatory requirements (to the extent they are not waived), including the
requirements in sections 1114 and 1115 of the ESEA to have schoolwide and targeted assistance programs that “use effective methods and
instructional strategies that are based on scientifically based research.”
II. GENERAL INFORMATION
School District Mailing Address Street, City, State, Zip
District Administrator E-Mail Address Telephone Area/No.
District Title I Coordinator E-Mail Address Telephone Area/No.
1. What is the reason the district is requesting this waiver?
2. Describe how the district will use funds freed-up by this waiver on other allowable Title I Part A activities.
3. Describe how the district plans to evaluate the progress of the district and of schools in improving the quality of instruction or the academic
achievement of students.
4. What is the approximate amount of the LEAs Title I, Part A-ARRA allocation that it seeks to exclude from the calculation of the per pupil amount
I HEREBY CERTIFY that the assurances listed above have been satisfied and that all facts, figures, and representation in this application are correct
to the best of my knowledge.
Signature of District Administrator Date Signed Mo./Day/Yr.
FOR DPI USE
Reason for Denial
Signature of Waiver Approver Date Signed Mo./Day/Yr.