File: LBD*-E

 

 

Intent to Apply to Become a District Charter School

(Sample Form)

 

Instructions:  All district charter school applicants must file this intent to apply form with the district at least ________ days before submitting an application to the Board of Education. The intent to apply form may be returned by fax to _____________ or email to ___________________________________. The form should also be the first document included in the district charter school application.

 

 

 

Date:  ___________________

Name of proposed district charter school:  ________________________________

Name of education management provider (EMP), if applicable:  __________________________________

 

Contact person:  ____________________________________________________

Mailing address:  ____________________________________________________

City:  ______________________________ State:  _______ Zip:  ______________

Daytime phone:  _______________________ Fax:  _________________________

Email:  ____________________________________________________________

 

___________________________________________________________________

 

Please respond to the following:

 

1.        Applicant(s) has/will file an application to charter this school or a substantially similar school with other authorizers:                          £ Yes   £ No     If yes, please list the other authorizer(s):  _______________________________________________

 

2.        Applicant(s) submitting this form: (Check appropriate statement)

         £ is incorporated in Colorado as a nonprofit

         £ has filed application to become a Colorado nonprofit

         £ (state type of entity, if other than above):  ____________________________

 

3.        If applicant intends to contract with an EMP, the corporate status of the EMP is:

         £ incorporated in Colorado as a nonprofit

         £ has filed application to become a Colorado nonprofit

         £ (state type of entity, if other than above):  ___________________________

 

4.        The proposed district charter school will be located within the boundaries of the school district in which this intent to apply form is submitted:                              £ Yes   £ No, the proposed district charter school will be located in __________________.

 

Adoption Date: Not Yet Adopted