FLORIDA DEPARTMENT OF EDUCATION
Request for Application (RFA)
Bureau / Office
Office of Independent Education and Parental Choice
Program Name
Public Charter Schools Federal Grant Program
2005-2006 Implementation Grant, Second-Year Application
Specific Funding Authority
Federal Funds: CFDA #84.282A – Title V, Part B, Subpart 1 (formerly Title X, Part C) of the
Elementary and Secondary Education Act of 1965, as amended by the No Child Left Behind Act of
2001
Funding Purpose/Priorities
To increase the number of high quality charter schools and improve student achievement by
providing financial assistance for the planning, program design, and initial implementation costs for
charter schools. Priority is to charter schools in the second year of operation.
Type of Award
Discretionary
Total Funding Amount
Approximately $11.8 million is available to be awarded to eligible applicants under the provisions of
the Public Charter Schools Federal Grant Program. It is anticipated that awards will not exceed
$200,000 per project.
Budget Period
July 29, 2005, or date the application is received by the Department of Education (DOE) in
substantially approvable form, through July 31, 2006.
Program Performance Period
July 29, 2005, or date the application is received by the Department of Education (DOE) in
substantially approvable form, through July 31, 2006.
Target Population
Students, parents, and staff who are served or employed by charter schools in the second year of
operation.
Eligible Applicants
Charter schools in the second year of operation.
Application Due Date
As soon as possible, but no later than July 29, 2005. The
due date refers to the date of receipt in
Grants Management, DOE by the close of business. Facsimile and email submissions will not be
accepted. Applications submitted after July 29 will not be effective until the date received by the
DOE in substantially approvable form and approval may be delayed.
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Contact Persons
Karen Bennett, Charter Schools, (850) 245-0867, Suncom (850) 205-0867, E-mail:
Karen.Bennett@fldoe.org
Sue Wilkinson, Grants Management, (850) 245-0496, Suncom (850) 205-0496, E-mail:
Sue.Wilkinson@fldoe.org
Assurances
The DOE has developed and implemented a document entitled, General Terms, Assurances and
Conditions for Participation in Federal and State Programs, to comply with:
34 CFR 76.301 of the Education Department General Administration Regulations (EDGAR)
which requires local educational agencies (LEAs) to submit a common assurance for
participation in federal programs funded by the U.S. Department of Education;
applicable regulations of other Federal agencies; and
State regulations and laws pertaining to the expenditure of state funds.
In order to receive funding, applicants must have on file with the DOE, Office of the Comptroller, a
signed statement by the agency head certifying applicant adherence to these General Assurances
for Participation in State or Federal Programs. The complete text may be found at
http://www.firn.edu/doe/comptroller/gbook.htm
School Districts, Community Colleges, Universities and State Agencies:
The certification of
adherence filed with the DOE Comptroller’s Office shall remain in effect indefinitely unless a
change occurs in federal or state law, or there are other changes in circumstances affecting a term,
assurance, or condition; and does not need to be resubmitted with this application.
NARRATIVE SECTION
For Federal Programs - General Education Provisions Act (GEPA)
In accordance with the requirements of Section 427 of the General Education Provisions Act
(GEPA) Public Law 103-382, each applicant for Federal funding must provide a concise description
of the steps proposed to ensure equitable access to, and participation of students, teachers, and
other program beneficiaries with special needs. For details, refer to URL:
http://www.ed.gov/policy/fund/guid/gposbul/gpos10.html.
Public Charter Schools Federal Grant Program Assurances
Current federal guidelines for the Public Charter Schools Grant Program require specific elements
be addressed by any charter school applying for these funds. Florida's standard charter
application process is sufficiently thorough and comprehensive enough that these required
elements have been almost fully addressed by the original charter application which is approved by
the local district school board prior to the operation of the charter school,
or
they will be included in
the narrative requirements of the project application. These elements
do not
need to be restated
or rewritten for the purposes of this project application, but the latest and most complete copy of
the charter school's approved application must be attached with this project application to the DOE
to document compliance with each of these elements.
If the original project narrative and
charter application fail to sufficiently address each of these federally required elements
listed in the Charter Schools Assurances provided in this the Request for Application (RFA),
then the applicant must submit additional narrative addressing the lacking issue(s).
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Relationship of Project to State Goals and Imperatives
The Florida Legislature has articulated four goals for the state’s K-20 educational and
accountability system that guide and direct educational activities. These goals are:
1.
Highest Student Achievement
2.
Seamless Articulation and Maximum Access
3.
Skilled Workforce and Economic Development
4.
Quality, Efficient Service
Adopting these goals as a foundation, the State Board of Education has identified eight Strategic
Imperatives as part of its long-range strategic planning effort to improve Florida’s education
system. One of these imperatives,
Strategic Imperative 5.0, Increase the Quantity and Improve
the Quality of Education Options,
places a priority on expanding and improving the quality of
school choice options that are available to Florida’s families.
As one of Florida’s fastest growing choice options, charter schools have a key role in helping to
accomplish this imperative. The funds from this project must be used to improve the quality of
charter schools in their second year of operation, thereby helping to expand and improve the
quality of school choice options for Florida parents and students.
Priority Areas and Required Activities
The project application must clearly describe how funds will be used to address each of the
following state requirements. Points will be awarded based on the extent to which the applicant
addresses each requirement.
1.
Overview of School Mission, Philosophy and Student Enrolllment (10 points)
State the mission and philosophy of the school, and identify any changes that have occurred
since the school received first-year implementation funds.
Describe the extent to which the school’s first-year implementation project objectives were
achieved and the final outcomes.
Describe any deviations from the obejctives or uses of funds stated in your first-year project
and reasons for the deviations.
State the school’s performance goals for the 2005-06 school year and describe how the
project funds will be used to achieve and measure the attainment of these goals.
Describe the school’s student population, including the number and demographic
composition of the students to be served. Note any changes in the student population to be
served in 2005-2006 from the school’s first-year implementation grant.
2.
Essential Areas for an Effective Charter School Program (75 points)
The DOE has identified the following five areas that are considered to be essential to the
implementation and success of high-quality charter schools. The application must describe
how the school will address
each
of the following essential areas.
Curriculum, Instruction, Assessment, and Accountability
Special Education Services
Business, Finance, and Accounting
Governance and Legal
Administration and Operations
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The description of the essential areas must include the following designated information.
Describe how the project funds will be used to align the school’s reading curriculum with the
Just Read, Florida!
initiative and, if applicable, the middle grades rigorous reading
requirement.
Describe how the project funds will be used in the professional development and in-service
training for school staff and administrators.
Describe how the charter school will serve students from special populations, including
students eligible for Exceptional Student Education (ESE) and Limited English Proficient
(LEP) students.
Explain the activities in the process used to develop an operating budget that shows the
fiscal viability of the school, including cash flow projections and an understanding of the
funding methods available to charter schools.
Explain the governing board’s role in the financial oversight of the school.
Describe your plan for creating a positive and productive relationship with the sponsoring
LEA.
Describe how the LEA and governing board of the charter school will provide for continued
operation of the school following expiration of this federal project.
Provide evidence to show that the charter school will have access on site to the Internet and
an email account that will be dedicated to charter school business to enable staff to receive
and transmit data, receive paperless communications, and exchange electronic
correspondence with state and local agencies.
Note
:
The application must state that the project recipient agrees to notify immediately the
Office of Independent Education and Parental Choice regarding any change in the school’s
charter status, administration, contact information, or other descriptive information that is
needed by the DOE to maintain a current database of all operating charter schools in Florida.
3. Budget Narrative (15 points)
Provide a narrative overview of how the funds will be used to support the mission and objectives
of the charter school. The budget narrative must be aligned with the essential program areas
addressed in the previous sections and consistent with information presented on the required
DOE 101 Budget Narrative Form that is submitted as part of the application.
Dissemination / Marketing
Information about the operation and accomplishments of charter schools receiving implementation
awards will be disseminated and marketed to appropriate populations through charter workshops,
conferences, and websites approved by the DOE.
Reporting Outcomes
Each charter school receiving these funds must prepare periodic financial reports of expenditures
related to the project for submission to the Office of Independent Education and Parental Choice.
Dates for submission of these reports will be stated in the Project Award Notification, DOE 200
form, under the terms and special conditions in section 12.
A final report must be submitted to the Office of Independent Education and Parental Choice.
These reports are not to be confused with the Project Disbursement Report DOE 399, which is
submitted by the school district to the DOE Comptroller’s office.
All project recipients must submit the DOE 399 form, Final Project Disbursement Report, by the
date specified on the DOE 200 form, Project Award Notification.
Funding Method
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Federal Cash Advance
–On-Line Reporting required monthly to record expenditures. Federal
cash advances will be made by state warrant or electronic funds transfer (EFT) to a recipient for
disbursements. For federally funded projects, requests for federal cash advance must be made on
the Electronic Federal Cash Advance Request System. If at times it is determined that
disbursements are going to exceed the amount of cash on hand plus cash in transit, an on-line
amendment can be made prior to the due date of the next Federal Cash Advance distribution on
the Electronic Federal Cash Advance Request System.
Fiscal Requirements
All funded projects and any amendments are subject to the procedures outlined in the Project
Application and Amendment Procedures for Federal an State Programs (Green Book) and the
General Assurances for Participation in Federal and State Programs
. These procedures and
documents can be accessed on-line at http://www.firn.edu/doe/comptroller/gbook.htm.
Supporting documentation for expenditures is required for all funding methods. Examples of such
documentation include invoices with check numbers verifying payment, and/or bank statements; all
or any of which must be available upon request.
Note
:
The charter school director, or the director’s designee, will be required to participate in the
Florida Annual State Charter School Conference to be held during the school year. Additionally,
the director or designee will be required to attend other specified DOE training and leadership
development workshops to be conducted during the school year in which funding is awarded.
Recipients may reserve project funding for participation in these required conferences and
workshops. The project application budget must reflect any funds to be used in meeting these
training requirements.
Recipients may reserve funding for participation in the statewide and national workshops and
conferences, including the required professional development and training described in this RFA.
The federal grant funds must supplement and not supplant the Florida Education Finance
Program.
Federal and state guidelines do not allow recipients to use these project funds for expenditures
which were encumbered prior to the official notification of a project award, as established by the
date of the Commissioner’s project award notification document.
The LEA may not deduct funds for indirect costs, including administrative fees or expenses,
from a sub-grant awarded to an eligible applicant, unless the eligible applicant enters
voluntarily into a mutually agreed upon arrangement for administrative services with the
relevant local educational agency. If indirect costs or other administrative fees to be used
by the school district are included in the project budget, a statement regarding the
agreement between the district and the charter school must be included in the budget
narrative.
Only schools that are in their second year of operation are eligible to respond to this Request for
Application. An eligible applicant receiving an award may use the funds, under federal guidelines,
for the following:
1.
Post-award planning and design of the educational program, which may include:
Refinement of the desired educational results and of the methods for measuring progress
toward achieving those results; and
Professional development of teachers and other staff who will work in the charter school.
2.
Implementation of the charter school, which may include:
Informing the community about the school;
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Acquiring necessary equipment and educational materials and supplies;
Acquiring or developing curriculum materials; and
Other initial operating costs that cannot be met from state or local sources.
These broad federal guidelines are clearly intended to give the charter school governing board
maximum flexibility to design a budget specific to the needs of the charter school. The DOE has
approximately $11.8 million dollars available for the 2005-2006 Implementation Grant, Second-
Year Application. It is anticipated that awards will not exceed $200,000 per charter school.
Upon advisement from the U.S. Department of Education, the following uses of project funds also
apply:
Renting/leasing and minor remodeling of facilities
is an allowable expenditure;
however, project funds for renting/leasing facilities may be used for a maximum of three
months prior to the opening of school. After this initial period, the costs of renting a facility
are considered ongoing operational expenses. Minor remodeling means minor alternations
to a previously completed building and includes the extension of utility lines, such as water
and electricity, from points beyond the confines of the space in which the minor remodeling
is undertaken but within the confines of the previously completed building. The term does
not include building construction, structural alterations to buildings, building maintenance, or
repairs.
Renovation of facilities
is an allowable expenditure; however, recipients are limited to
expenditures for installation of a fire alarm, sprinkler system, and minor renovations
required for compliance with the Americans with Disabilities Education Act (ADA) such as
installation of an entry-way ramp or bathroom stall bars. Installing elevators for ADA
purposes or removing asbestos or installing fire retardant ceiling panels and carpet, are not
allowable uses.
Employment of staff (salaries
) is an allowable expenditure; however, recipients are
limited to
three months prior to the opening of school
for a principal and/or head teacher
to assist the school with its planning and design. Under special conditions, a charter school
may pay salaries for personnel that were not anticipated such as a full time special
education teacher. In order to pay any salaries over and above the three-month limit
specified above, the school/district would need to submit to the DOE for prior written
approval, a program and budget amendment to their approved project application.
The general rule of thumb for use of project monies is that they be used for items that will directly
impact a student such as school equipment (e.g., desks, microscopes, bulletin boards, overheads,
and LCD projectors), textbooks, computers, library and media materials, professional development
of teachers, and policy and governing board training.
Restrictions
– (Some
unallowable
expenses)
Food
Playground
equipment
Construction
Major
renovation
Installing elevators for ADA purposes
Removing
asbestos
Installing fire retardant ceiling panels and carpet
School
marquees
Note:
Charter School Program grant funds cannot support pre-school grades. The Charter School
Program is authorized under the Elementary and Secondary School Act (ESEA) and supports K-12
programs only.
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Conditions for Acceptance
The requirements listed below must be met for applications to be considered for review:
1.
One (1) original and three (3) copies of the completed application are received in DOE
within the timeframe specified by the RFA.
2.
Application includes required forms: DOE 100A – Application and DOE 101 – Budget
Narrative.
Note:
Applications signed by officials other than the appropriate agency head
identified above must have a letter signed by the agency head, or documentation citing
action of the governing body delegating authority to the person to sign on behalf of said
official. Attach the letter or documentation to the DOE 100A when the application is
submitted.
3.
Assurances page submitted with original signature, without modification, assuring that all
special requirements and activities will be met.
4.
Application includes the signed ED 80-0013 - Certifications Regarding Lobbying,
Debarment, Suspension and Other Responsibility Matters and Drug-Free Workplace
Requirements form.
5.
Copy of the current charter application.
6.
Copy of the approved charter (if available).
7.
Application must be submitted to:
Bureau of Grants Management
Florida Department of Education
325 W. Gaines Street, Room 325
Tallahassee, Florida 32399-0400
8.
Project Narrative that describes how the project will address each of the areas described in
this RFA.
Note
:
This section of the application must not exceed ten (10) pages.
Method of Review
Project applications will be screened by DOE program staff to assure that guidelines of all
federal regulations and state requirements in the RFA have been addressed. Applications that
meet all state and federal requirements will then be evaluated by peer reviewers with expertise
in planning and design of charter school programs. Project applications receiving a score of
less than 70 points will not be funded; however, applicants will be authorized to resubmit
revised applications should they choose to do so. Technical assistance will be made available
to any applicant scoring less than 70 points. The DOE may require revisions to applications
where weaknesses have been identified.
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DOE 100A
Revised 01/05
John L. Winn, Commissioner
Instructions for Completion of DOE 100A
A. If not pre-printed, enter name of the program for which funds are requested.
B. Enter name and mailing address of eligible applicant. The applicant is the public or non-
public entity receiving funds to carry out the purpose of the project.
C. Enter the total amount of funds requested for this project.
D. Enter requested information for the applicant’s contact person. This is the person
responsible for responding to all questions regarding information included in this
application.
E. State whether school is a traditional charter or a conversion.
F. If the school has an affiliation with a municipality, university, community college, and/or
management company, please indicate.
G. The original signature of the appropriate agency head is required. The agency head is
the school district superintendent, university or community college president, state
agency commissioner or secretary, or the president/chairman of the governing board for
other eligible applicants.
Note:
Applications signed by officials other than the appropriate agency head (must
have a letter signed by the agency head, or documentation citing action of the governing
body delegating authority to the person to sign on behalf of said official. Attach the letter
or documentation to the DOE 100A when the application is submitted.
11. An assurance that the eligible applicant will cooperate with the Secretary, U.S.
Department of Education and the Florida Department of Education in evaluating the
charter school assisted under this subpart.
12. A description of how a charter school that is considered a local educational agency
under state law, or a local educational agency in which a charter school is located, will
comply with sections 613(a)(5) and 613(e)(1)(B) of the Individuals with Disabilities Act.
PART II:
FLORIDA REQUIRES AN APPLICANT FOR A GRANT UNDER THE FEDERAL CHARTER SCHOOL PROGRAM TO DOCUMENT
THE FOLLOWING ASSURANCES. ON A SEPARATE PAGE, ATTACH AN EXPLANATION FOR ANY ASSURANCE MARKED
“NO.”
ASSURANCES
YES
NO
1. Funds received under this grant will be used to supplement and, to the extent practical,
increase the level of funds that would be made available from nonfederal sources, and
in no case will such funds be used to supplant funds from nonfederal sources.
2. Activities will be implemented which are consistent with state and federal fiscal and
program requirements.
3. The charter school will maintain accurate and timely project records which document
progress in implementing this project, and which demonstrate compliance with all
state and federal fiscal and program requirements.
4.
The charter school and the district will provide all information required by the Florida
Department of Education for fiscal audit, program evaluation and annual reporting to
the U.S. Department of Education
.
5. The charter school will provide the Secretary, U.S. Department of Education and the
Florida Department of Education any information that may be required to determine if
the charter school is making satisfactory progress toward achieving the objectives
described in its charter.
6. The charter school will cooperate with the Secretary, U.S. Department of Education and
the Florida Department of Education in evaluating the charter school assisted under this
program.
7. The charter school will submit a timely annual report to the school district and to the
Florida Department of Education, as required by Section 1002.33, Florida Statutes,
containing all the information required by law.
CERTIFICATION IS HEREBY GIVEN THAT ALL FACTS, FIGURES, AND REPRESENTATIONS MADE IN THIS
APPLICATION WITH REGARD TO PARTICIPATION OF THE ORGANIZATION OR ENTITY SPECIFIED ABOVE
ARE TRUE AND CORRECT.
NAME AND TITLE OF AUTHORIZED REPRESENTATIVE (TYPED):
_____________________________________________________ _____________________
SIGNATURE OF AUTHORIZED REPRESENTATIVE DATE SIGNED
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Certifications Regarding Lobbying; Debarment, Suspension, and Other Responsibility Matters; and Drug-Free Workplace Requirements
Applicants should refer to the regulations cited below to determine the certification to which they are required to attest. Applicants should also review the
instructions for certification included in the regulations before completing this form. Signature of the form provides for compliance with certification requirements
under 34 CFR Part 82, "New Restrictions on Lobbying," and 34 CFR Part 85, "Government-wide Debarment and Suspension (Nonprocurement) and
Government-wide Requirements for Drug-Free Workplace (Grants)." The certifications shall be treated as a material representation of fact upon which reliance
will be placed when the Department of Education determines to award the covered transaction, grant, or cooperative agreement.
1. Lobbying
As required by Section 1352, title 31 of the U.S. Code, and implemented at 34
CFR Part 82, for persons entering into a grant or cooperative agreement over
$100,000, as defined at 34 CFR Part 82, Sections 82.105 and 82.110, the
applicant certifies that:
(a) No Federal appropriated funds have been paid or will be paid, by or on
behalf of the undersigned, to any person for influencing or attempting to
influence an officer or employee of any agency, a Member of Congress in
connection with the making of any Federal grant, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment,
or modification of any Federal grant or cooperative agreement;
(b) If any funds other than Federal appropriated funds have been paid or will
be paid to any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of
Congress, or an employee of a Member of Congress in connection with the
Federal grant or cooperative agreement, the undersigned shall complete and
submit Standard Form - LLL, "Disclosure Form to Report Lobbying," in
accordance with its instructions;
(c) The undersigned shall require that the language of this certification be
included in the award documents for all subawards at all tiers (including
subgrants, contracts under grants and cooperative agreements, and
subcontracts) and that all subrecipients shall certify and disclose accordingly.
______________________________________________________________
2.
Debarment, Suspension, and Other Responsibility Matters
As required by Executive Order 12549, Debarment and Suspension, and
implemented at 34 CFR Part 85, for prospective participants in primary
covered transactions, as defined at 34 CFR Part 85, Sections 85.105 and
85.110 --
A.
The applicant certifies that it and its principals:
(a) Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by any Federal
department or agency;
(b) Have not within a three-year period preceding this application been
convicted of or had a civil judgment rendered against them for commission of
fraud or a criminal offense in connection with obtaining, attempting to obtain, or
performing a public (Federal, State, or local) transaction or contract under a
public transaction; violation of Federal or State antitrust statutes or commission
of embezzlement, theft, forgery, bribery falsification or destruction of records,
making false statements, or receiving stolen property;
(c) Are not presently indicted for or otherwise criminally or civilly charged by a
governmental entity (Federal, State, or local) with commission of any of the
offenses enumerated in paragraph (1)(b) of this certification; and
(d) Have not within a three-year period preceding this application had one or
more public transactions (Federal, State, or local) terminated for cause or
default; and
B. Where the applicant is unable to certify to any of the statements in this
certification, he or she shall attach an explanation to this application.
______________________________________________________________
3. Drug-Free Workplace (Grantees Other Than Individual)
As required by the Drug-Free Workplace Act of 1988, and implemented at
34 CFR Part 85, Subpart F, for grantees, as defined at 34 CFR Part 85,
Sections 85.605 and 85.610--
A.
The applicant certifies that it will or will continue to provide a drug-free
workplace by:
(a) Publishing a statement notifying employees that the unlawful manufacture,
distribution, dispensing, possession, or use of a controlled substance is
prohibited in the grantee's workplace and specifying the actions that will be
taken against employees for violation of such prohibition;
(b) Establishing an on-going drug-free awareness program to inform
employees about--
(1) The dangers of drug abuse in the workplace;
(2) The grantees policy of maintaining a drug free workplace;
15
(3) Any available drug counseling, rehabilitation, and employee assistance
programs; and
(4) The penalties that may be imposed upon employees for drug abuse
violations occurring in the workplace;
(c) Making it a requirement that each employee to be engaged in the
performance of the grant be given a copy of the statement required by
paragraph (a);
(d) Notifying the employee in the statement required by paragraph (a) that, as
a condition of employment under the grant, the employee will--
(1) Abide by the terms of the statement; and
(2) Notify the employer in writing of his or her conviction for a violation of a
criminal drug statute occurring in the workplace no later than five calendar
days after such conviction;
(e) Notifying the agency, in writing, within 10 calendar days after receiving
notice under subparagraph (d)(2) from an employee or otherwise receiving
actual notice of such conviction. Employers of convicted employees must
provide notice, including position title, to: Director, Grants and Contracts
Service, U.S. Department of Education, 400 Maryland Avenue, S.W. (room
3124, GSA Regional Office Building No. 3), Washington, D.C. 20202-4571.
Notice shall include the identification number(s) of each affected grant;
(f) Taking one of the following actions within 30 calendar days of receiving
notice under subparagraph (d)(2), with respect to any employee who is so
convicted --
(1) Taking appropriate personnel action against such an employee, up to and
including termination, consistent with the requirements of the Rehabilitation Act
of 1973, as amended; or
(2) Requiring such employee to participate satisfactorily in a drug abuse
assistance or rehabilitation program approved for such purposes by a Federal,
State, or local health, law enforcement, or other appropriate agency;
(g) Making a good faith effort to continue to maintain a drug-free workplace
through implementation of paragraphs (a), (b), (c), (d), (e), and (f).
B. The grantee may insert in the space provided below the site(s) for the
performance of work done in connection with the specific grant:
Place of Performance (street address, city, county, state, zip code)
______________________________________________________________
______________________________________________________________
_____________________________
Check
if there are workplaces on file that are not identified here.
Drug-Free Workplace (Grantees who are Individuals)
As required by the Drug-Free Workplace Act of 1988, and implemented at 34
CFR Part 85, Subpart F, for grantees, as defined at 34 CFR Part 85, Sections
85.605 and 85.610 --
A. As a condition of the grant, I certify that I will not engage in the unlawful
manufacture, distribution, dispensing, possession, or use of a controlled
substance in conducting any activity with the grant; and
B. If convicted of a criminal drug offense resulting from a violation occurring
during the conduct of any grant activity, I will report the conviction, in writing,
within 10 calendar days of the conviction, to: Director, Grants and Contracts
Service, U.S. Department of Education, 400 Maryland Avenue, S.W. (room
3124, GSA Regional Office Building No. 3), Washington, D.C. 20202-4571.
Notice shall include the identification number(s) of each affected grant.
As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above certifications.
NAME OF APPLICANT
PRINTED NAME AND TITLE OF AUTHORIZED CHARTER SCHOOL REPRESENTATIVE
SIGNATURE
DATE SIGNED
