independent textbook adoption modified 3 11 by CQkc23E

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									 Oregon Department of Education                                                                      Office of Educational Improvement and Innovation
 Public Service Bldg                                                                                              State Instructional Materials Services
 255 Capitol St NE                                                                                  http://www.ode.state.or.us/go/InstructionalMaterials
 Salem OR 97310
                                       Notification of District Independent Textbook Adoption

 In accordance with Oregon Revised Statute (ORS) 337.141 school districts may adopt and use textbooks or
 other instructional materials in place of or in addition to those adopted by the State Board of Education
 provided they meet the guidelines and criteria established by the State Board of Education.


 District Name                                        Address                                                City                                       Zip

 ESD Name                                             ESD Address                                            City                                       Zip



 Contact Person Name                                                                                         Telephone Number

 List below the instructional materials for independent textbook adoption:


 Subject __________________________________ Category___________________                                                         Grade Level

 Title of Instructional Material

 Publisher                                                                                      Publication Date                      Copyright Date


 Date adoption approved by local school board                                                     Date of intended installation


                Required Statements of Assurance (Must be checked in order for ODE to accept Notification)

    Our school district has assurance from the publishers agreeing to comply with the most current National
 Instructional Materials Accessibility Standard (NIMAS) specifications regarding accessible instructional materials. For
 more information visit http://nimas.cast.org. NIMAS applies to materials published after 7/19/06.

     Our school district has completed the criteria checklist indicating the degree to which the instructional materials
 meet the criteria established by the State Board of Education and has these on file at the School District Office. Valid only
 for the period ending with the close of the current state adoption period for the subject area identified. Criteria checklists
 may be obtained from Department of Education, Office of Educational Improvement & Innovation, State Instructional
 Materials Office, by calling (503) 947-5746 or e-mail paula.merritt@state.or.us or visiting our web site:
 http://www.ode.state.or.us/go/instructionalmaterials


___
 Signature of Approving Superintendent                                                        Please Print Name

 ..........................................................................................................................................................................
                                                                   For Department Use Only


      Date Notification Received                                 Date Copy Sent to ESD                              Date Confirmation Letter Sent

      Date Copy Sent to Standards                                                      to Subject Specialist
 Form 581-4542-X (Rev. 3/11)

								
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