GRA Nomination Form, Framework and Instructions

U.S. Department of Education - Green Ribbon Schools

2011-2012 Presentation of State Evaluation of School

Nominee to the U.S. Department of Education

Part I – Principal and Superintendent Eligibility Certification……..2

Part II – Summary of Achievements .…………………………………4

Part II – Documentation and Certification of State Nomination………4

Attach State or Nominating Authority’s Evaluation of School Nominee (Either application or other documentation of review)

____________

Public Burden Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 37 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is required to obtain or retain benefit P.L. 107-110, Sec. 501, Innovative Programs and Parental Choice Provisions. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20202-4536 or email [email protected] and reference the OMB Control Number 1860-NEW. Note: Please do not return the completed Green Ribbon Schools Application to this address.

PART I ‑ ELIGIBILITY CERTIFICATION

School and District’s Certifications

The signatures of the school principal and district superintendent (or equivalents) on the next page certify that each of the statements below concerning the school’s eligibility and compliance with the following requirements is true and correct.

1. The school has some configuration that includes one or more of grades K-12. (Schools on the same campus with one principal, even a K-12 school, must apply as an entire school.)

2. The school achieves or comes close to achieving the goals of all three green Ribbon Pillars: 1) environmental impact and energy efficiency; 2) healthy school environments; and 3) environmental and sustainability education.

3. The school has been evaluated and selected from among schools within the state or Nominating Authority’s jurisdiction (BIE, DoDEA), based on quantified achievement toward the three Green School Pillars and Elements.

4. Neither the nominated public school nor its public school district is refusing the U.S. Department of Education Office of Civil Rights (OCR) access to information necessary to investigate a civil rights complaint or to conduct a district wide compliance review.

5. OCR has not issued a violation letter of findings to the public school district concluding that the nominated public school or the public school district as a whole has violated one or more of the civil rights statutes. A violation letter of findings will not be considered outstanding if OCR has accepted a corrective action plan to remedy the violation.

6. The U.S. Department of Justice does not have a pending suit alleging that the public school or the public school district as a whole has violated one or more of the civil rights statutes or the Constitution’s equal protection clause.

7. There are no findings of violations of the Individuals with Disabilities Education Act in a U.S. Department of Education monitoring report that apply to the public school or public school district in question; or if there are such findings, the state or public school district has corrected, or agreed to correct, the findings.

8. The school meets all applicable federal, state, tribal and local health, environmental and safety requirements in law, regulations and policy and are willing to undergo EPA on-site verification.

U.S. Department of Education

2012 Green Ribbon Schools

For Public Schools only: (Check all that apply) [ ] Charter [ ] Title I [ ] Magnet [ ] Choice

Name of Principal

(Specify: Ms., Miss, Mrs., Dr., Mr., etc.) (As it should appear in the official records)

Official School Name

(As it should appear in the official records)

School

Mailing Address_________________________________________________________________

(If address is P.O. Box, also include street address.)

_______________________________________________________________________________ City State Zip

County _________________________ State School Code Number*_______________________

Telephone ( ) Fax ( )

Web site/URL E-mail

I have reviewed the information in this application, including the award and eligibility requirements on page 2-4, and certify that to the best of my knowledge all information is accurate.

Date____________________________

(Principal’s Signature)

Name of Superintendent*

(Specify: Ms., Miss, Mrs., Dr., Mr., Other)

District Name* Tel.( )

I have reviewed the information in this application, including the award and eligibility requirements on page 2-4, and certify that to the best of my knowledge all information is accurate. I concur that this is one of the highest performing green school applicants in our state.

Date____________________________ (Superintendent’s Signature)

*Private Schools: If the information requested is not applicable, write N/A in the space.

P ART II – SUMMARY OF ACHIEVEMENTS

Instructions to School Principal

Provide a concise and coherent "snapshot" that describes how your school is representative of your state’s highest achieving green school efforts in approximately 600-800 words. Summarize your strengths and accomplishments. Focus on what makes your school worthy of the title U.S. Department of Education Green Ribbon School. Be sure to note if students were actively involved in preparing the application.

This summary should be written as a stand-alone document. It will provide the ED review panel with an overview of the school’s green activities that were detailed in the application to the state, DoDEA or BIE evaluators. If the school is awarded a Green Ribbon, this information may be shared with other schools, candidates for next year, the press, and the public.

PART III – DOCUMENTATION OF STATE EVALUATION OF NOMINEE

Instructions to Nominating Authority

For the pilot year, the Nominating Authority must review nominated schools for high achievement based on the schools’ quantified achievement¹ toward reaching the goals of each of the three Green School Pillars and elements.²

For each school being nominated by the Authority to ED, please attach state (or equivalent) evaluation materials (application) based on the Nominating Authority Evaluation Support Framework provided by ED to facilitate your evaluation of schools.

The Nominating Authority must review and sign the following certification for each school being nominated to ED.

Nominating Authority’s Certifications

The signature by the Nominating Authority (the CSSO, DoDEA or BIE) on this page certifies that each of the statements below concerning the school’s eligibility and compliance with the following requirements is true and correct.

1. The school has some configuration that includes one or more of grades K-12. (Schools on the same campus with one principal, even a K-12 school, must apply as an entire school.)

2. The school achieves or is one of those overseen by the Nominating Authority which comes the closest to achieving the goals of all three green Ribbon Pillars: 1) environmental impact and energy efficiency; 2) healthy school environments; and 3) environmental and sustainability education.

3. The Nominating Authority has evaluated the school and selected it for submission to the U.S. Department of Education from among those schools overseen by the Nominating Authority which have applied for a Green Ribbon, based on quantified achievement toward the three Green School Pillars and Elements.

4. The school meets all applicable federal civil rights and federal, state, tribal and local health, environmental and safety requirements in law, regulations and policy and are willing to undergo EPA on-site verification.

Name of Nominating

Agency

Name of Nominating

A uthority

(Specify: Ms., Miss, Mrs., Dr., Mr., Other)

I have reviewed the information in this application, including the award and eligibility requirements on pages 2-4, and certify, to the best of my knowledge through a documentary verification assessment, that the school meets the provisions in this Part of the Nominee Presentation Form.

Date____________________________

(Nominating Authority’s Signature)

Note to Nominating Authority: The application, including the signed certifications and documentation of evaluation in the three pillars should be converted to a PDF file and emailed to Director, ED-Green Ribbon Schools at [email protected] according to the instructions in the Nominee Submission Procedure.

1

? The quantified assessment should be based on the common metrics provided in state level evaluator guidance.

2 In future years, evaluators will be required to review the school community’s comprehensive green school plan that incorporates, at a minimum, the plan elements listed under “The Three Pillars and Elements,” and a

baseline assessment for each of the elements of the plan; however, this documentation is not a requirement in the pilot year.

ED-GRS (2011-2012) Page 5 of 5