CHARTER SCHOOL CAPITAL OUTLAY PLAN

In each year that funds are appropriated for charter school capital outlay purposes, the Commissioner of

Education shall allocate the funds among eligible charter schools (Section 1013.62(1), F.S.)

Prior to the transfer of funds to the charter school, this form must be completed and the information verified

and approved by the charter school governing board and sponsoring district.

CHARTER SCHOOL INFORMATION

DISTRICT INFORMATION

Charter School Name

District Name

Street Address

For School Year

$

City, State, Zip Code

Amount of Money Expected for the School Year

Telephone Number

District Charter School Liaison Name and Phone Number

Charter School Contact and Phone Number

District Finance Officer Contact Name and Phone Number

SECTION 1:

Pursuant to Section 1013.62 (1), F.S., to be eligible for a funding allocation, a charter school must:

(Districts shall verify that these requirements have been met by checking all boxes in this section.)

(a) enter into an agreement with the charter school which includes provisions for the reversion of

any unencumbered funds and all equipment and property purchased with public education funds

to the ownership of the district school board in the event that the school terminates operations, and

(b) serve students in facilities that are not provided by the charter school's sponsor and is not directly or

indirectly operated by the school district.

SECTION 2:

Pursuant to Section 1013.62 (7), F.S., the funds shall be allocated according to schools that meet at

least one of the following criteria. Please check the box(es) that apply.

(1) Received funding in F/Y 2002-2003.

(2) Are an expanded feeder pattern (as defined in the DOE Definition of Terms) of a school that

received funding in FY 2002-2003.

(3) Has an approved charter and serves students at the start of 2003-04 and either incurred

long-term (5 years or more) financial obligations prior to January 31, 2003, or began

construction on educational facilities prior to December 31, 2002.

SECTION 3:

Pursuant to Section 1013.62, F.S., a charter school's governing body may use charter school capital outlay

funds only for the following purposes. Please check the box(es) that apply.

(a) Purchase of real property.

(b) Construction of school facilities.

(c) Purchase, lease-purchase, or lease of permanent or relocatable school facilities.

(e) Renovation, repair, and maintenance of school facilities that the charter school owns

or is purchasing through a lease-purchase or long-term lease of 5 years or longer.

Certification:

As the Charter School Governing Body Representative, I certify that all information provided is accurate and current.

As the District Finance Officer, I certify that I have documentation on file and available for inspection that substantiates the

Charter School Capital Outlay eligibility requirements as written in statute and listed above in sections 1 and 2. Also,

as Finance Officer, I commit to verify purchases as written in statute and listed above in section 3.

Charter School Governing Body Signature

District Finance Officer Signature

Please mail or fax this form, with all signatures affixed, to: Janet Burns, Office of Educational Facilities,

325 West Gaines Street, Room 1004, Tallahassee, FL 32399 - Fax 850-245-9243.