LBD-E-1

File: LBD-E-1 (pdf)
Adopted: February 28, 2017

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INTENT TO APPLY TO BECOME A DISTRICT CHARTER SCHOOL

Instructions:  All district charter school applicants must file this intent to apply form with the district at least 30 days before submitting an application to the District. The intent to apply form may be returned by hand delivery or email to superintendent@bvsd.org. 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:  _______________________
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 Boulder Valley School District in which this intent to apply form is submitted: [  ] Yes    [  ] No

If no, the proposed district charter school will be located in ____________________________.

5.  Grade levels to be served and student enrollment per grade for first 5 years.

Grade	Pre-K	K	1	2	3	4	5	6	7	8	9	10	11	12
1st year
2nd year
3rd year
4th year
5th year

 

6. Projected demographics:

 

	% ELL	% SPED	% FRL
1st year
2nd year
3rd year
4th year
5th year

 

7. Name of proposed principal and current employment:
______________________________________________________________________________

8. Model or focus of proposed school:
______________________________________________________________________________

9. Explain the circumstance and motivations that brought the applicant team together to propose this charter school.
______________________________________________________________________________
______________________________________________________________________________

End of File: LBD-E