ORLEANS PARISH SCHOOL BOARD 2017 Charter School Request For Applications John Brown, Sr., District 1 Ethan Ashley, District 2 Sarah Newell Usdin, District 3 Leslie Ellison, District 4 Benjamin Kleban, District 5 Woody Koppel, District 6 Nolan Marshall Jr., District 7 Part 1: Notice of Intent to Apply & Eligibility Documentation For Charter Schools seeking to open beginning in the 2018-19 school year Dr. Henderson Lewis, Jr. Superintendent 0 ORLEANS PARISH SCHOOL BOARD 2017 Charter School Application Table of Contents Introduction ............................................................................................................................................................... 2 Autonomy and Accountability ............................................................................................................................... 2 2017 OPSB Charter School Application...................................................................................................................... 3 2017 Full Application Timeline .............................................................................................................................. 4 Proposal Evaluation Process .................................................................................................................................. 4 Additional Resources ............................................................................................................................................. 5 New/Existing Operator Application Tracks: ........................................................................................................... 6 Demonstrated Support Procedures ....................................................................................................................... 7 Applicant Code of Conduct .................................................................................................................................... 7 Public Disclosure .................................................................................................................................................... 7 District Primary Contact ......................................................................................................................................... 7 2017 Charter School Application Part 1:.................................................................................................................... 8 Application Guidelines: OPSB Charter School Application – Part 1 ....................................................................... 8 Components of Notice of Intent Packet: ............................................................................................................... 8 Submission Instructions: OPSB Charter Application – Part 1 .............................................................................. 10 Proposal Overview Form ......................................................................................................................................... 11 Teacher Eligibility Form ....................................................................................................................................... 15 Board Member Eligibility Form ............................................................................................................................ 16 Assurances Form .................................................................................................................................................. 17 1 ORLEANS PARISH SCHOOL BOARD 2017 Charter School Application Introduction Across New Orleans, more than 90 percent of public school students currently attend charter schools. These schools have led to a dramatic increase in the number of students meeting academic proficiency standards and the performance gap between students in Orleans Parish and Louisiana as a whole has dramatically decreased over the last 10 years. The 2017 charter school application process seeks proposals from highly qualified applicants to open new Type 1 charter schools and transform existing public schools into Type 3 charter schools. This process helps OPSB ensure that every student in New Orleans has equal access to high quality schools where their interests will come first, where they and their families will have choice, and where educators will have the tools and support they need to be successful. Autonomy and Accountability Charter schools that are authorized by OPSB have broad autonomy, including substantial authority to make decisions related to personnel decisions, school management and operations, finance, curriculum, school day and calendar, and Education Service Provider (ESP) agreements. In exchange for these autonomies, charter schools must meet rigorous accountability measures, as established by:  District Policy (http://opsb.us/wp-content/uploads/2015/06/SECTION-H1.pdf )  Charter School Demonstrations Program Law (https://www.louisianabelieves.com/docs/call-to-actiontoolbox/charter-school-law.pdf?sfvrsn=0). Adherence to these standards is measured via OPSB’s Performance Framework (http://opsb.us/charterschools/charter-school-performance-framework/), which directly corresponds with the components of a strong charter school application, as well as the key areas of responsibility outlined in charter contracts. These areas are guided by three fundamental questions, the answers of which are essential to a comprehensive evaluation of charter school performance:  Is the educational program a success?  Is the school financially viable?  Is the organization effective and well run? Charter schools are evaluated annually against standards in the following categories:  Academic Performance – Charter schools are required to make demonstrable improvements in student performance over the term of the charter. Schools are required to administer all state standardized tests and to adhere to academic standards. Schools are required to serve students with exceptionalities.  Financial Performance – Schools must demonstrate the proper use of public funds, as evidenced by annual balanced budgets, sound audit reports, and conforming to generally accepted accounting practices.  Organizational Performance – A nonprofit corporation holds the charter school contract and is responsible for complying with both the terms in the contract and all applicable laws. The charter school board of directors is a public body and required to adhere to public meeting and public records laws. 2 ORLEANS PARISH SCHOOL BOARD 2017 Charter School Application Approved charter schools are granted a five-year charter, contingent upon results of the reporting requirements at the end of the third year. Schools unable to demonstrate academic progress or unable to comply with legal/contractual or financial requirements may face sanctions or charter revocation. 2017 OPSB Charter School Application The 2017 OPSB Charter School Application contains the following two components: Part 1: OPSB Charter School RFA Notice of Intent & Eligibility Type 1: New Start Schools Type 3: Conversion of an Existing Public Schools* Part 2: Louisiana Common Charter Application and OPSB Supplemental Materials Notice of Intent & Eligibility Documentation Deadline for both Type 1 New Start and Type 3 Conversion charter schools are due by 12:00 p.m. CST on Friday, January 27, 2017 Louisiana Common Charter Application & OPSB Supplemental Materials due, for both Type 1 New Start and Type 3 Conversion Schools by 12:00 p.m. CST on Friday, February 24th, 2017 Early Eligibility Review: The OPSB Portfolio Office will provide prospective applicants with a review of eligibility documentation prior to the final submission deadline. Applicants wishing to receive an Early Eligibility Review must submit documents via FluidReview by no later than 12:00 p.m. CST, Friday, January 20, 2017. This packet contains only Part 1: Notice of Intent to Apply & Eligibility Determination. Part 2 materials, including the OPSB Charter School Application, Supplemental Application, and Type 3 Demonstrated Support Procedures, will be released online by December 16, 2017. Applicants will be provided detailed instructions regarding this portion of the application once eligibility has been confirmed. Instructions for completing and submitting the application will also be posted to the Application page of the OPSB’s Portfolio Office website, http://www.opsb.us/charter-schools/applications-3/. 3 ORLEANS PARISH SCHOOL BOARD 2017 Charter School Application 2017 Full Application Timeline The following timeline is tentative and subject to revision. All changes will be posted to the Applications page of the Charter School Office website, and notification will be provided to the application primary contact person. 2017 OPSB RFA Process Timeline MILESTONE/TASK RFA Release Part 1: Eligibility Review Deadline Part 1: Notice of Intent & Eligibility Documentation Deadline Type 1 & 3 Final Eligibility Determinations Part 2: Type 1 and Type 3 – Complete Applications due Final Completeness re-check Requests for Clarification presented to applicants Deadline for applicant responses to Request for Clarification Capacity Interviews Evaluator Recommendations presented to applicants and OPSB staff Deadline for applicant response to evaluator recommendation Public Hearing (OPSB Accountability Committee) OPSB Board Business Meeting – Final Decisions DATE (ALL TIMES CT) November 15, 2016—Part 1 December 16, 2016—Part 2 Noon, January 20, 2017 Noon, January 27, 2017 February 3, 2017 Noon, February 24, 2017 March 10, 2017 March 31, 2017 Noon, April 12, 2017 April 17- 19, 2017 May 1, 2017 5pm, May 5, 2017 May 11, 2017 (TENTATIVE) May 16, 2017 (TENTATIVE) Proposal Evaluation Process OPSB’s quality criteria for charter application have been established in accordance with state statutes, consultations with local and national experts, and other best-practice research. All submissions will be evaluated by both an independent review team and the local school district. OPSB has established strategic priorities to guide its charter authorization efforts, based on an assessment of the district’s needs and future goals. Alignment with the district’s strategic priorities will be considered as a primary factor for all applicants in the proposal evaluation process. The 2017 OPSB Charter Authorizing & Portfolio Strategic Priorities can be found here: http://opsb.us/wp-content/uploads/2015/12/2016-Strategic-Priorities.pdf . Independent review teams and the school district serve different roles in the charter evaluation process:  Independent review teams provide recommendations on written charter submissions and practical interviews, performance tasks, and site visits. Recommendations provided by the independent review teams after each stage are based only on submitted application information, performance during the Interview stage of the application process, and objective information (such as past school performance data) collected by the school district.  While the purpose of the independent review teams is to recommend, the responsibility of the local school board is to decide – and the local school district is responsible for considering all information in helping the local school board make the best informed decisions possible.  In addition to the input and data considered by the independent review teams, the local school district’s input to the local school board also considers external factors, such as an applicant’s overall alignment with the school district’s strategic priorities and the school district’s interactions with applicants in other contexts. 4 ORLEANS PARISH SCHOOL BOARD 2017 Charter School Application Because of the different roles independent experts and the local school district play, recommendations produced by independent review teams and the broader input provided by the local school district to the local school board may not result in identical recommendations. Additional Resources Embedded within this application are links and directions to various informational resources for new school applicants. The evaluation criteria may also serve as a resource to applicants. However, it is the applicant’s responsibility to collect all the compliance and regulatory information necessary to open and operate a charter school in the state of Louisiana. The resource notations are for your assistance but are not comprehensive. The Louisiana Department of Education and Louisiana Association of Public Charter Schools have a strong desire to see qualified charter applicants succeed in the charter application process. In addition to the resources compiled by the district to which an applicant applies, the following resources have been assembled to: (a) Ensure that applicants recognize the choice option they are most qualified to provide; and (b) Provide applicants with information and guidance that may be helpful in putting together a successful proposal. Resource Description Location Call to Action Toolbox  Includes an interactive dashboard that visually guides applicants towards the geographic, demographic, and academic areas of greatest need Link Louisiana Association of Public Charter Schools Research Library The mission of the Louisiana Association of Public Charter Schools (LAPCS) is to support, promote and advocate for the Louisiana charter school movement, increasing student access to high quality public schools statewide. LAPCS provides tools and information through their research library that may be of use to applicants. Link BESE Policies Bulletin 126 spells out the rules and regulations that govern charter schools. Link Louisiana Department of Education Charter School Library As the authorizer of multiple charter schools throughout the state, Louisiana Department of Education (LDE) has compiled a library of resources aimed at informing charter school applications, review, and ongoing monitoring. Applicants should note, LDE Performance Compact and application timelines do not supersede Orleans Parish’s own. Please refer to OPSB materials regarding performance evaluation and application timelines. Link 5 ORLEANS PARISH SCHOOL BOARD 2017 Charter School Application New/Existing Operator Application Tracks: The OPSB Charter School Application process provides charter applicants with a choice of customized application tracks most relevant to their background and organizational capabilities:  New Operator Application Track – appropriate for groups that have little to no experience running charter schools. This track will offer applicants an early assessment of whether or not their application is viable, avoiding unnecessary effort and costs.  Experienced Operator Application Track – appropriate for experienced charter operators that have several successful schools in operation in Louisiana and / or nationwide. This track will immediately focus on the past performance of existing schools and the operational elements of the applicant’s plan to expand operations in under-served communities in Louisiana. Each application track will have requirements most appropriate for an applicant’s background and proven capabilities. Applicants should select the appropriate application track, using the following table for guidance. Track New Operator Track Qualifications Eligibility Criteria Non-profit group:  has never operated a charter school and/or  does not intend to employ an educational service provider or intends to employ an educational service provider that has never operated a school Experienced Operator Track  The non-profit must submit a signed eligibility confirmation form, acknowledging that all eligibility requirements will be met at the appropriate time  Local school boards may require Type 3 takeover applicants to submit evidence of parent and teacher support per established policies. Applicants considering a Type 3 takeover should contact the local school district to determine what is required.  The non-profit must submit signed eligibility confirmation form acknowledging that all eligibility requirements will be met at the appropriate time (see the Letter of Intent) Non-profit group:  has operated one or more charter school(s) and/or  intends to employ an educational service provider that has operated one or more school(s)  Local school boards may require Type 3 takeover applicants to submit evidence of parent and teacher support per established policies. Applicants considering a Type 3 takeover should contact the local school district to determine what is required. 6 ORLEANS PARISH SCHOOL BOARD 2017 Charter School Application Demonstrated Support Procedures UPDATED January 2017: La statute RS 17:3973 stipulates that charter schools authorized by the state Board of Elementary and Secondary Education directly must be approved by the faculty/staff and parents of the school’s existing student body through a vote. The same statute provides that local school districts, like Orleans Parish School Board, have no such requirement. In evaluating proposals for both new and existing charter schools, OPSB requests that applicants include in their proposal evidence of parent and community support. In the past, this has taken the form of votes, letters of support, petitions, and other evidence. No one format is required. Last year, Orleans Parish School Board’s charter application required Demonstrated Support Procedures for Type 3 charter applicants. Votes will not be required for the 2017 Charter RFA process. Applicant Code of Conduct Members of OPSB are obligated to make decisions in the best interests of children, free from personal or political influences. Similarly, charter school applicants have the responsibility of respecting and upholding the integrity of the charter school application process. Specifically, charter school applicants shall not:  Initiate, or attempt to initiate, any activity with an Orleans Parish School Board member that is prohibited by the Code of Governmental Ethics;  Direct any communications, including application documents, to an Orleans Parish School Board member at any point during the application submission and evaluation process. Charter school applicants found to be in violation of these requirements may be deemed ineligible for consideration of charter school approval. Public Disclosure All charter school proposals submitted to OPSB are considered public records, pursuant to the Louisiana Public Records Law, LSA-R.S. 44:1 et seq., and are subject to public release. Type 3 Conversion: Demonstrated Support Procedures Louisiana law (R.S. 17:3983) permits chartering entities to require applicants seeking to convert a preexisting school to demonstrate that their proposal is supported of a majority of parents and/or certificated faculty & staff. The Orleans Parish School Board may require demonstrated support from both parents and staff at any preexisting school proposed to be converted to a Type 3 charter school, prior to consideration of the application by the district. NOTE: Pursuant to current state law and BESE policies, the Orleans Parish School Board is unable to accept proposals from applicants seeking to convert a school currently under the jurisdiction of the Recovery School District (RSD) to a Type 3 charter school. District Primary Contact For any questions or concerns regarding the 2017 OPSB Charter School RFA or charter school application evaluation process, please contact Taina Knox, Director of New Schools and Programs, by email at taina_knox@opsb.us. 7 2017 Charter School Application Part 1: Notice of Intent to Apply & Eligibility Documentation Application Guidelines: OPSB Charter School Application – Part 1 The Orleans Parish School Board (OPSB) is pleased to invite applicants for new quality charter schools seeking to open in Fall 2018 (or thereafter) to submit a Notice of Intent and Eligibility Documentation. Please note that the OPSB Notice of Intent Packet incorporates elements of the LDOE Charter Applicant Eligibility Requirements. The Notice of Intent & Eligibility Review is a mandatory process required for all nonprofit corporations seeking to submit an application to operate a charter school authorized by OPSB. This component of the application provides an opportunity for applicants to demonstrate their qualifications under state law and district policy, and to address any deficiencies that may prevent their application from being considered by the Board. Louisiana law sets out specific requirements for all groups submitting charter applications. All applicants must meet these eligibility requirements in order to submit a full application. • • Only nonprofit organizations may hold charters in Louisiana Application teams must include three Louisiana teachers certified by the State Board of Elementary and Secondary Education The OPSB Portfolio Office will provide prospective applicants with a single review of eligibility documentation prior to the submission deadline. Applicants wishing to receive an Early Eligibility Review must submit documents, via the Fluid Review portal (here: https://opsb-charter-rfa.fluidreview.com/) no later than 12:00 p.m. CST, Friday, January 20, 2017. Components of Notice of Intent Packet:  Proposal Overview form: The Proposal Overview gives the OPSB Portfolio Office an overview of your charter school proposal and provides the context by which your proposal will be evaluated.  Eligibility Documentation form: The Eligibility Documentation form asks applicants to provide proof of eligibility to be approved for a charter school application. By reviewing eligibility requirements early on, the OPSB Portfolio office provides applicants the opportunity to address potential issues with eligibility and successfully submit a charter school application.  o Background information for all identified board members and school leader (if identified) o Assurances that your non-profit is registered in good standing with the Louisiana Secretary of State, is non-sectarian in nature, and that your proposed school will not be the conversion of a private school or home study program Supporting Documentation to Indicate Eligibility: Applicants are required to provide the following documentation of their eligibility: o Valid, active teaching Certificates for all teachers involved in the development of the application o Resumes and background checks for all identified board members and school leader (if identified) 8 ORLEANS PARISH SCHOOL BOARD Eligibility Documentation Form Completion of the following forms is required for Charter Application: Part 1 – Notice of Intent: Proposal Overview Form The Proposal Overview gives the OPSB Portfolio Office an overview of your charter school proposal and provides the context by which your proposal will be evaluated. Teacher Eligibility Form Louisiana state law requires that all groups submitting charter applications involve three Louisiana teachers certified by the State Board of Elementary and Secondary Education in the development of their application. Please use this form to identify the certified teachers participating in the development of this application. Board Eligibility Form Louisiana state law requires a minimum of seven board members in order to execute a valid charter agreement, and at all times that a charter school is operational. In addition, LA. R.S. 17:3991 board policy places additional restrictions on familial relationships and involvement of public officials in charter school boards. Finally, OPSB Policy HA stipulates that charter school governing boards must have a minimum of 60% parish residency and include a parent authorized by OPSB must include at least one parent or legal guardian of one or more students currently enrolled at any school operated by that governing board in Orleans Parish. Please use this form to list the proposed board members for the non-profit applying to open this school. In order to be eligible to apply, applicants are required to have at least three board members. In order to be eligible for final Board approval, applicants are required to have five board members. Full policy compliance will be required within 3 months of the school starting classes. Assurances Form Please complete the Assurances & Certification page of the OPSB Supplemental Eligibility Documentation, indicating that all of the following are true:  Your non-profit is registered and listed as in good standing with the Louisiana Secretary of State. Non-profit status can be checked at the Secretary of State’s website here: http://www.sos.la.gov/tabid/819/Default.aspx  Your non-profit is non-sectarian in nature, and is not supported by or affiliated with a religion or religious organization or institution  Your proposed school will not be the conversion of a private school or a home study program  Your proposed school will participate in common enrollment, common expulsion processes, offer free transportation, and operate in accordance of OPSB Policy HA Support for Type 3 Conversion UPDATED – JANUARY 2017: Last year, Orleans Parish School Board’s charter application required Demonstrated Support Procedures for Type 3 charter applicants. Votes will not be required for the 2017 Charter RFA process. 9 ORLEANS PARISH SCHOOL BOARD Eligibility Documentation Form The following sets of eligibility documentation must be included in the eligibility documentation submission: Teacher Certification Please include, in your Teacher documentation submission, copies of valid, active teaching certificates for each identified teacher. Background Information For all identified board members (and for your proposed CEO/school leader), please provide:   Current one-page resume Copy of fingerprints and evidence of submission of LA State Police Background Check Please note that background checks for all identified board members and proposed school leader(s) will be required prior to Board action on any application. Receipt of background check results may take up to 90 days. Therefore, we strongly encourage all applicants to begin collecting this documentation well in advance. To receive a valid background check in the mail, please use either 1. The internet background check, here: https://ibc.dps.louisiana.gov/); or 2. Authorization form, here: http://www.lsp.org/pdf/Bureau_Authorization_Form.pdf If you are an applicant on the experienced operator track, and your applicant group has already filed board member background checks with another authorizer, a letter from an employer or district authorizer indicating an LA State Background check was performed with no significant findings is sufficient. Submission Instructions: OPSB Charter Application – Part 1 Applicants will submit materials for Part 1: Notice of Intent & Eligibility Documentation electronically through the Fluid Review platform. To register to submit materials, please visit the OPSB Fluid Review website. If you have questions or require technical support, please contact Taina Knox (taina_knox@opsb.us) 1. Complete the Proposal Overview form provided in the Notice of Intent packet. o The Primary Application Contact must sign the final page of this form. Applicants applying for multiple schools must complete one Proposal Interview form for EACH proposed school. 2. Complete the Eligibility Documentation form provided in the Notice of Intent packet, and provide all required documentation. o The Assurances page of this form must be signed by the President/Chair of the board of directors of the nonprofit organization submitting the application. 3. Combine all documents into a single PDF file. Name your file according to the following convention: o NAME OF OPERATOR.2017IntenttoApply.pdf 4. Submit your responses to OPSB Portfolio Office via Fluid Review website. o Applicants: submit the packet as a single PDF file no later than 12:00 p.m. CST on Friday, January 27, 2017. Late submissions will not be accepted. 5. Applicants will receive final responses by the OPSB Portfolio Office no later than Friday, February 3, 2017. 10 ORLEANS PARISH SCHOOL BOARD Eligibility Documentation Form Proposal Overview Form Notice of Intent to Apply and Eligibility Documentation for all Type 1 (New Start) and Type 3 (Existing School Conversion) Charter Schools must be submitted no later than 12:00 p.m. CST on Friday, January 27, 2017. Notice of Intent and Eligibility Documentation should include only the information requested below, saved in a single PDF file, submitted via the Fluid Review portal (here: https://opsb-charter-rfa.fluidreview.com/) as part of the Notice of Intent packet. Non-Profit Information Name of Non-Profit Applicant (as registered with Louisiana Secretary of State) Type 1 Type 3 New Experienced Application Track Application Type & Track (new/experienced) Primary Contact Information Name Address Phone Email School Leader Information Proposed school leader name (if identified) Proposed school leader current job/position List any principal/leadership programs the proposed leader is currently enrolled in or have completed (e.g., NLNS, BES, etc.) 11 ORLEANS PARISH SCHOOL BOARD Eligibility Documentation Form School Information Proposed School Name Opening Year Grades served Year 1 Grades served at capacity Proposed School Description School Model Specialty (check all that apply) Alternative Disability (list): Arts Language Immersion Blended Learning Military Career and Technical Education Montessori College Prep STEM Other (list): Virtual In 100 words or less, briefly describe the mission and vision of your proposed school 12 ORLEANS PARISH SCHOOL BOARD Eligibility Documentation Form School Enrollment Projection Provide the following information for each school included in this proposal. Specify the planned year of opening for each (duplicating the table as needed). School Name: _______________________________________________________________________________ Number of Students Grade Level Year 1: Year 2: Year 3: Pre-K K 1 2 3 4 5 6 7 8 9 10 11 12 PLANNED ENROLLMENT MAXIMUM ENROLLMENT 13 Year 4: Year 5: Year at Capacity: ORLEANS PARISH SCHOOL BOARD Eligibility Documentation Form Do any of the following describe your organization or any of the school(s) proposed in this application? Will contract or partner with an education service provider (ESP) or other organization to provide school management services. If so, identify the provider: Will have a corporate partner as defined in LA R.S. 17 3991.1. If so, identify the partner: Will reflect the conversion of an existing public school (Type 3 application). If so, identify the school: The primary learning environment for students enrolled in the school will be virtual. Already operates schools in Louisiana or elsewhere in the US (indicate which state(s) below) Certification I certify that I have the authority to submit this application and that all information contained herein is complete and accurate. I recognize that any misrepresentation could result in disqualification from the application process or revocation after award. The person named as the contact person for the application is so authorized to serve as the primary contact for this application on behalf of the organization. Signature of Application Primary Contact Date Print Name & Title of Application Primary Contact 14 ORLEANS PARISH SCHOOL BOARD 2017 Notice of Intent to Apply Teacher Eligibility Form Louisiana state law requires that all groups submitting charter applications involve a minimum of three Louisiana teachers certified by the State Board of Elementary and Secondary Education in the development of their application. Please use this form to identify the certified teachers participating in the development of this application. Also, please be sure to include a copy of current LA Teacher Certification for the teachers listed. Name Street Address Zip-code 1 2 3 15 Phone Email ORLEANS PARISH SCHOOL BOARD Eligibility Documentation Form Board Member Eligibility Form Please list all the proposed board members for the non-profit applying to open this school. In order to be eligible to apply, applicants are required to have at least three board members. In order to be eligible for final Board approval, applicants are required to have five board members. State law requires a minimum of seven board members in order to execute a valid charter agreement, and at all times that a charter school is operational. Please also include a current resume and LA State Background check for each board member identified. Name Street Address Zip-code 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 16 Phone Email ORLEANS PARISH SCHOOL BOARD Eligibility Documentation Form Assurances Form Please review the statements below and indicate whether each is true, and will hold true if the application is approved. If the answer to any item above is “No”, please submit a statement of explanation. Yes No 1. The school and/or governing organization is currently registered as a non-profit and is listed as in good standing with the Louisiana Secretary of State 2. The school is not affiliated with any religious organization and does not support nor engage in any religious activities 3. The school and/or governing organization does not have any liens, litigation history and/or sanctions from any local, state and/or federal regulatory agency against the nonprofit corporation 4. The school and/or governing organization does not have the same or substantially the same board of directors and/or officers as an existing private school 5. The school does not draw a substantial portion of the employees from an existing private school 6. The school does not receive a substantial portion of assets or property from an existing private school 7. The school is not located at the same site as an existing private school 8. The school will participate in the city-wide common enrollment (OneApp) process 9. The school will participate in the city-wide common expulsion process 10. The school will provide free transportation to students as stipulated in OPSB Policy HA Certification I certify that I have the authority to submit this application and that all information contained herein is complete and accurate, realizing that any misrepresentation could result in disqualification from the application process or revocations after award. Name of Board Chair and Charter Governing Board Signature of Board Chair Date 17