New Charter School Affidavit

Transcription

1 New Charter Schl Affidavit This dcument prvides instructins and frms t submit a new charter schl affidavit (affidavit) t the Minnesta Department f Educatin (MDE) prir t the creatin f a new charter schl by an apprved authrizer. The request is submitted by an apprved authrizer n behalf f a develping charter schl. Affidavit requests are based n statutry requirements and are evaluated against the terms and cnditins set frth in the cmmissiner-apprved authrizer applicatin and quality f materials submitted. An authrizer may als submit a revised affidavit in state fiscal year 2014 (SFY 2014) fr a develping r new charter schl (in its first three years f peratin) that wishes t gain fficial recgnitin f its prekindergarten r preschl instructinal prgram. Minnesta Statutes, sectin 124D.10, Subdivisin 4(b): Befre the peratrs may establish and perate a schl, the authrizer must file an affidavit with the cmmissiner stating its intent t charter a schl. An authrizer must file a separate affidavit fr each schl it intends t charter. The affidavit must state the terms and cnditins under which the authrizer wuld charter a schl and hw the authrizer intends t versee the fiscal and student perfrmance f the charter schl and t cmply with the terms f the written cntract between the authrizer and the charter schl bard f directrs under Subdivisin 6. The cmmissiner must apprve r disapprve the authrizer's affidavit within 60 business days f receipt f the affidavit. If the cmmissiner disapprves the affidavit, the cmmissiner shall ntify the authrizer f the deficiencies in the affidavit and the authrizer then has 20 business days t address the deficiencies. If the authrizer des nt address deficiencies t the cmmissiner's satisfactin, the cmmissiner's disapprval is final. Failure t btain cmmissiner apprval precludes an authrizer frm chartering the schl that is the subject f this affidavit. Please Nte: An eligible rganizatin must be currently apprved t authrize charter schls prir t submitting an affidavit t MDE (per Minn. Stat. 124D.10, Subd. 3(c)). An apprved authrizer must first review and evaluate the new schl s applicatin accrding t Minnesta Statutes, sectin 124D.10, Subdivisin 3(d)(3) and the prcess articulated in the cmmissiner-apprved authrizer applicatin prir t submitting an affidavit t MDE. An apprved authrizer f a develping r new charter schl (in its first three years f peratin) that desires t ffer a prekindergarten r preschl instructinal prgram t serve children between three years f age t kindergarten entry and gain fficial recgnitin by MDE as prviding instructin fr children yunger than five years f age pursuant t Minnesta Statutes, sectin 124D.10, Subdivisin 8(f) must submit a revised new schl affidavit that includes the schl s plan t ffer the prekindergarten r preschl instructinal prgram and the authrizer s plans t versee the prgram. Revised new schl affidavits will nly be accepted in SFY 2014 and will nt be an ptin after June 30, Instructins: The authrizer must address the requirements cntained belw t submit a new charter schl affidavit t MDE (per Minn. Stat. 124D.10, Subd. 4(b)). Revised affidavits shuld reflect updated infrmatin fr all Parts, as applicable, t address the new charter schl s prekindergarten r preschl instructinal prgram. 1

2 NOTE: Tips are prvided based n previusly successful affidavits. Instructins prvided in the tips are nt specifically required by statute, but are designed t ensure a cmprehensive affidavit respnse. Part A Submissin Eligibility & Affidavit Frms Prf f meeting eligibility criteria must be submitted as part f the affidavit and eligibility criteria must be met befre an affidavit will be reviewed. Prvide all requested infrmatin. I. Cmplete the New Charter Schl Affidavit Cver Sheet (Frm 1). II. Cmplete the Authrizer Eligibility Certificatin (Frm 2) and include attachments if applicable. III. Cmplete the Schl Funders Cntact Infrmatin (Frm 3). IV. Cmplete the Authrizer Assurance and Certificatin (Frm 4). V. Cmplete the Schl Assurance and Certificatin (Frm 5). VI. Ntice t Schl District: Attach a cpy f the ntificatin letter(s) the charter schl develper r authrizer sent t the schl district(s) in which the new charter schl prpses t lcate. TIP: Applicants are encuraged t ntify a schl district at least 14 business days befre an affidavit is submitted. Part B Terms and Cnditins f the New Schl I. Executive Summary: Present the terms and cnditins under which the authrizer wuld charter a schl pursuant t Minnesta Statutes, sectin 124D.10, Subdivisin 4(b): TIP: Prvide an executive summary (up t tw single-spaced pages) that includes: A cmpelling need fr the new schl; TIP: Helpful dcumentatin f cmpelling need includes evidence f supprt frm current r prspective families, enrllment statistics frm nearby public schls, etc. The schl s bradly inclusive missin and visin statements; Statutry purpse(s) the schl will address (must specify that the prpsed schl s primary purpse is t imprve pupil learning and student achievement per Minnesta Statutes, sectin 124D.10, Subdivisin 1(a)); Grade levels and ttal number f students t be served; Intended lcatin and facility address, if identified; Targeted pening date; Statement f the schl s educatinal philsphy and instructinal apprach; and Hw the schl plans t imprve student achievement and exceed the academic perfrmance f existing public schls in the targeted service area. TIP: In rder t supprt the need fr the schl and identify plans t imprve student achievement and exceed the academic perfrmance f existing public schls, sme data abut the current perfrmance f existing schls in the area shuld be prvided. II. Student Perfrmance Expectatins: Present the accuntability gals fr the new schl (i.e., specific academic and nnacademic utcmes per Minnesta Statutes, sectin 124D.10, Subdivisin 6(3)). Please limit yur respnse t tw single-spaced pages. TIP: One r mre accuntability gals shuld clearly address the primary purpse t imprve pupil learning and student achievement per Minnesta Statutes, sectin 124D.10, Subdivisin 1(a). TIP: Each gal shuld be presented as a specific gal with a single type f measure, that may r may nt include annual indicatrs f success. 2

3 TIP: Accuntability gals shuld include measurable perfrmance indicatrs (e.g., quantifiable targets) fr the pre-peratinal and peratinal perids under the initial charter cntract. TIP: Ensure that the accuntability gals presented match the academic perfrmance indicatrs that are included as measures fr schl success within the apprved authrizer applicatin (i.e., parts B.II and E.I shuld be aligned). TIP: MDE encurages the use f a SMART gal frmat t present accuntability gals. Fr infrmatin regarding SMART gals, visit the Q Cmp page f MDE s website. Part C Authrizer Capacity Minnesta Statutes, sectin 124D.10, Subdivisin 3(d)(2). Please limit this part t tw single-spaced pages. I. Explain hw the apprval f this new schl is cnsistent with the Capacity and Infrastructure sectin f yur apprved authrizer applicatin. TIP: Discuss hw the additin f this new schl is cnsistent with the Capacity & Infrastructure sectin f yur apprved authrizer applicatin (including the number, size and type f schls nted in yur prtfli). TIP: Clearly identify the authrizer liaisn and ther individual(s) wh will versee the new schl and indicate the amunt f persnnel time dedicated t the versight f this new schl. TIP: Explain the need fr any changes in the capacity r structure f yur rganizatin if the new schl is apprved. Part D Authrizer s Review Prcess Minnesta Statutes, sectin 124D.10, Subdivisin 3(d)(3). Please limit this part t five single-spaced pages. I. Cnsistent with the cmmissiner-apprved authrizer applicatin, describe the applicatin and review prcess used t determine apprval f this new charter schl applicatin. TIP: Prvide a summary f review data including quantitative results (e.g., scres, ratings, rankings) and qualitative results (e.g., evaluative cmments, interview feedback, strengths and weaknesses) generated by the authrizer s review prcess (ne- t twpage summary f results r a cpy f review summary already generated by the authrizer). Indicate hw any identified weaknesses were specifically addressed during the review prcess. TIP: Prvide a ne-page summary f review prcess activities cnducted by the authrizer (e.g., review activities, timeline/key dates, names f reviewers, invlvement f rganizatinal leadership in prcess, final actin). Include specific page number citatin(s) frm the cmmissiner-apprved authrizer applicatin t demnstrate the new schl applicatin was reviewed cnsistent with apprved plans. TIP: Prvide a ne-page analysis f the review prcess results that justifies apprval f the new schl, including the qualificatins f schl funders/develpers and hw they were thrughly vetted t verify a track recrd f success. Describe hw any weaknesses identified during the review prcess were specifically addressed. Part E Oversight and Cmpliance (Please limit this part t five single-spaced pages.) 3

4 I. Oversight f Perfrmance: Present hw the authrizer intends t versee the fiscal and student perfrmance f the charter schl " that is cnsistent with the cmmissinerapprved authrizer applicatin and Minnesta Statutes, sectin 124D.10, Subdivisin 4(b). TIP: Oversight plans shuld clearly reflect hw perfrmance under the primary purpse t imprve pupil learning and student achievement per Minnesta Statutes, sectin 124D.10, Subdivisin 1(a) will be evaluated. TIP: Oversight plans shuld include a descriptin f the types f perfrmance data t be cllected, when data will be cllected, and hw data will be analyzed against perfrmance indicatrs (identified in Part B.II abve) fr the pre-peratinal and peratinal perids under the initial charter cntract. TIP: If applicable, perfrmance versight f the schl s prekindergarten r preschl instructinal prgram shuld be specifically addressed. II. Cmpliance: Present hw the authrizer intends t cmply with the terms f the written cntract between the authrizer and the charter schl bard f directrs that is cnsistent with the cmmissiner-apprved authrizer applicatin and Minnesta Statutes, sectin 124D.10, Subdivisin 4(b). TIP: Cmpliance plans shuld address the pre-peratinal and peratinal perids under the initial charter cntract. TIP: If applicable, cmpliance f the schl s prekindergarten r preschl instructinal prgram shuld be specifically addressed. Part F (OPTIONAL) Early Learning Prgrams (Prekindergarten and Preschl Instructinal Prgrams) An authrizer f a new charter schl (nt yet chartered) that desires fr the charter schl t ffer a prekindergarten r preschl instructinal prgram t serve children between three years f age t kindergarten entry, and gain fficial recgnitin by MDE as prviding instructin fr children yunger than five years f age pursuant t Minnesta Statutes, sectin 124D.10, Subdivisin 8(f), must cmplete this sectin f the affidavit. An authrizer f a develping r new charter schl (in its first three years f peratin) that desires t ffer an fficially recgnized prekindergarten r preschl instructinal prgram must submit a revised affidavit t MDE that addresses this sectin. This ptin is nly available until June 30, Official recgnitin will prvide an pprtunity t access available state and federal resurces t prvide high-quality early learning prgrams. The affidavit/revised affidavit must present the schl s plans t address the fllwing elements: I. Cmprehensive Child Assessment: Assess each child's cgnitive skills with a cmprehensive child assessment instrument when the child enters and again befre the child leaves the prgram t infrm prgram planning and prmte kindergarten readiness. TIP: Describe the assessment prcess used t measure individual child prgress in all the prekindergarten and preschl instructinal classes that includes the use f a standardized child assessment instrument, such as High Scpe Child Observatin Recrd (COR), Teaching Strategies Gld r Wrk Sampling System. T measure child prgress, the assessment must be used at prgram entrance and prgram exit. At a minimum, the cmprehensive assessment shuld measure children s prgress in the dmains f language and literacy and mathematical thinking. Other dmains may include appraches t learning, general cgnitive 4

5 develpment, physical and mtr develpment, scial and emtinal develpment, creativity and the arts. II. III. IV. Intentinal Instructinal Practice: Prvide intentinal instructinal practice aligned with the state early childhd learning standards and kindergarten standards that is based n early childhd research and prfessinal practice fcused n children's cgnitive, scial, emtinal, and physical skills and develpment and prepares children fr the transitin t kindergarten, including early literacy skills. TIP: Describe hw prgram cntent and intentinal instructinal practices are aligned with the Early Childhd Indicatrs f Prgress: Minnesta s Early Learning Standards (ECIPs) available n the MDE website and include a very brief descriptin f the curriculum used in the early learning prgram, such as High Scpe Preschl Curriculum r Opening the Wrld f Learning (OWL). Indicate hw the Early Childhd Indicatrs f Prgress: Minnesta s Early Learning Standards (ECIPs) are incrprated int the prgram. Prvide an verview f instructinal practice t supprt children s early literacy skills develpment. Kindergarten Transitin: Crdinate apprpriate kindergarten transitin with parents and kindergarten teachers. TIP: Briefly describe the prgram plan fr transitin t kindergarten that includes meaningful crdinatin and planning with kindergarten teachers, and engages families in a variety f ways t supprt children s learning and successful transitin t kindergarten. Crdinate with Relevant Cmmunity-Based Services. TIP: Crdinatin may include referrals t cmmunity prgrams based n child needs, such as lcal public health, scial services, mental health services, r ther early learning r child care prgrams. Prvide a brief descriptin f hw the prgram crdinates with cmmunity rganizatins. V. Staff Ratis and Licensure: Ensure staff-child ratis f ne-t-ten and maximum grup size f 20 children with the staff being supervised by a licensed early childhd teacher. TIP: Briefly describe hw the prekindergarten r preschl instructinal prgram is prvided and hw ratis and grup size are prvided t ensure a high-quality early learning prgram. Fr each prekindergarten and preschl instructinal class, describe staff licensure and ther credentials, as apprpriate. VI. VII. Teacher Cntent Knwledge: Have teachers knwledgeable in early childhd curriculum cntent, assessment, and instructin. TIP: Describe licensed staff training n early learning curriculum and/r assessment that has been cmpleted in the past five years. Early Childhd Screening: Ensure participating children have cmpleted health and develpmental screening within 90 days f prgram enrllment under Minnesta Statutes sectin 121A.16 t 121A.19. TIP: Prvide a descriptin f hw participating children receive health and develpmental screening thrugh a traditinal schl district r cmparable screening frm health care prvider (such as a Child and Teen Checkups). It is nt necessary fr the charter schl t prvide the health and develpmental screening, but must describe hw children receive the cmprehensive health and develpmental screening t identify pssible prblems that may interfere with children s learning. 5

6 Submissin Instructins: Affidavits may be submitted t MDE anytime. MDE respectfully requests that authrizers submit affidavits n later than Octber 1 st f the year prir t the schl s first year f peratin t allw fr the review prcess and t ensure a sufficient pre-peratinal develpment perid befre the new schl begins serving students. Hwever, this late timeline des nt prvide ptimal funding pprtunities. The cmmissiner has 60 business days t review and cmment n the affidavit per Minnesta Statutes, sectin 124D.10, Subdivisin 4(b). The authrizer has 20 business days t address, t the cmmissiner's satisfactin, any deficiencies in the initial affidavit per Minnesta Statutes, sectin 124D.10, Subdivisin 4(b). The cmmissiner s apprval r disapprval f an affidavit is final. Page numbers shuld be included thrughut the submissin. Identify and sequence materials in rder accrding t the utline abve. When cmpleting frms, type requested infrmatin int grey frm fields befre printing. Duble-check t make sure all required signatures are present and visible. Assurance and Certificatin frms (Frms 4 and 5) need t be signed and dated by apprpriate parties befre being scanned with ther elements. Submit nly cmplete affidavits; incmplete submissins will nt be reviewed. Affidavits must be submitted electrnically; hard cpies will nt be reviewed. Scan all elements as ne PDF and the PDF submissin t MDE (as a single attachment) t: marsha.davis-busch@state.mn.us. MDE will cnfirm receipt f an affidavit within tw business days. Please cntact Marsha Davis- Busch at (651) if a cnfirmatin is nt received within tw days f submissin. NEED ASSISTANCE? Please r call Marsha with questins. If submitting questins via , reference New Charter Schl Affidavit in the subject line f yur message. 6

7 Check One: Initial Affidavit New Charter Schl Affidavit Cver Sheet Frm 1 Revised Affidavit t add Early Learning Prgram (must be submitted n later than June 30, 2014) NAME OF APPROVED AUTHORIZER: NAME OF NEW CHARTER SCHOOL: Name f Primary Schl Cntact New Schl Cntact Infrmatin (Mailing address, phne number and address) Authrizer Liaisn s Name Authrizer Infrmatin (Mailing address, phne number and address) Prpsed Opening Date Where will the Schl be Lcated? (If applicable, list all available addresses f ptential sites being cnsidered) Is this new charter schl a cnversin f an existing district public schl (Minn. Stat. 124D.10, Subd. 5)? If yes, attach a separate sheet with an explanatin. A cnversin request is cnsidered nly with evidence f a petitin frm at least 60% f a schl s full-time teachers seeking cnversin and apprved public schl district N (authrizer) bard meeting minutes recgnizing the petitin. Will this new charter schl include an Early Learning Prgram? Yes N (If yes, check all that apply belw. Must cmplete Part F f the new charter schl affidavit Instructins.) Early Childhd Health and Develpmental Screening (Part F des nt need t be cmpleted if nly Screening will be prvided.) Preschl instructinal prgram (nt prekindergarten) fr children ages 3-5 years Anticipated size f preschl instructinal prgram: (enter estimated number f children t be served annually) Prekindergarten instructinal prgram fr fur-year-lds t prepare children fr entry int kindergarten the fllwing year Anticipated size f pre-kindergarten instructinal prgram: served annually) Is this new charter schl planning t incrprate nline, digital, r blended learning? If yes, an additinal applicatin and apprval frm MDE may be required. Cntact Debrah.Prctr@state.mn.us fr mre infrmatin. Yes (enter estimated number f children t be Yes N 7

8 Is this new charter schl planning t incrprate prject-based learning? If yes, an additinal applicatin may be required cntact Mary.Barrie@state.mn.us fr mre infrmatin. Is this new charter schl planning t incrprate wrk-based learning? If yes, an additinal applicatin may be required cntact Al.Hauge@state.mn.us fr mre infrmatin. Grade Levels Schl will Serve when Fully Enrlled (elementary and/r secndary grades) Yes N Yes Number f Students Schl will Serve when Fully Enrlled (elementary and/r secndary grades) N Cmplete the fllwing table t identify the number f students expected t attend the schl each year by grade level in the fllwing table (elementary and/r secndary students nly). Add additinal rws if it will take mre than five years t reach full enrllment. Year f Operatin K Ttal One Tw Three Fur Five 8

9 NAME OF APPROVED AUTHORIZER: NAME OF NEW CHARTER SCHOOL: New Charter Schl Affidavit Authrizer Eligibility Certificatin Frm 2 Check the apprpriate bx (Minn. Stat 124D.10, Subd 3(b)): Independent schl district schl bard, intermediate schl under Minnesta Statutes, sectins 123A.15 t 123A.19. district bard, r educatin district rganized Charitable rganizatin under sectin 501(c)(3) f the Internal Revenue Cde f 1986 (exclusins apply; see Minn. Stat 124D.10, Subd 3(b) fr cmplete infrmatin.) Include the fllwing dcumentatin immediately after this frm; clearly label each attachment: Attachment A: Dcumentatin f the authrizer s current status under sectin 501(c)(3) f the Internal Revenue Cde f TIP: Search the IRS website, print results screen with date. Attachment B: Dcumentatin t evidence the authrizer s current membership with the Minnesta Cuncil f Nnprfits r the Minnesta Cuncil n Fundatins (membership must be active when the affidavit is submitted). Attachment C: Dcumentatin f the authrizer s active registratin with the Office f the Minnesta Attrney General when the affidavit is submitted t MDE. TIP: Search the Attrney General s website, print results screen with date. Attachment D: Dcumentatin t evidence the rganizatin has been incrprated in the state f Minnesta and has been perating cntinuusly fr at least five years frm the date f affidavit submissin. TIP: Search the Minnesta Business & Lien System n the Minnesta Secretary f State s website, print results screen with date. Attachment E: Dcumentatin t verify the rganizatin des nt perate a charter schl. TIP: Include a signed letter, n rganizatinal letterhead, t verify this requirement. Institutin f higher educatin; check the authrizer categry the rganizatin meets: Minnesta private cllege that grants tw- r fur-year degrees and is registered with the Minnesta Office f Higher Educatin under Minnesta Statutes, sectin 136A; Minnesta private cllege that grants tw- r fur-year degrees and is registered with the Minnesta Office f Higher Educatin under Minnesta Statutes, sectin 136A; Cmmunity cllege, state university, r technical cllege, gverned by the Bard f Trustees f the Minnesta State Clleges and Universities; r The University f Minnesta. Single-Purpse Authrizer Charitable, nnsectarian rganizatin frmed under sectin 501(c)(3) f the Internal Revenue Cde and incrprated in the state f Minnesta whse sle purpse is t charter schls. Als include the fllwing dcumentatin immediately after this frm; clearly label each attachment: Attachment A: Dcumentatin f the authrizer s current status under sectin 501(c)(3) f the Internal Revenue Cde f TIP: Search the IRS website, print results screen with date. Attachment B: Dcumentatin f the authrizer s active registratin with the Office f the Minnesta Attrney General when the affidavit is submitted t MDE. TIP: Search the Attrney General s website, print results screen with date. 9

10 New Charter Schl Affidavit Schl Funders Cntact Infrmatin Frm 3 NAME OF APPROVED AUTHORIZER: NAME OF NEW CHARTER SCHOOL: Prvide infrmatin fr individuals directly and significantly invlved in the develpment f this new charter schl (e.g., funders, bard members and develpers). 1 Name Phne Number Address New Schl Bard Member (check if bard member r intending t serve as a bard member) 2 Minnesta Teacher License File Flder & Expiratin Date (if applicable) 3 1 Include nly primary schl funders and develpers n this list; please d nt include persns merely cnsulted in the develpment f the new schl r the authrizer liaisn n this list. 2 Minnesta Statutes, sectin 124D.10, Subdivisin 4d stipulates that: A charter schl bard f directrs must be cmpsed f at least five members wh are nt related parties. 3 Minnesta Statutes, sectin 124D.10, Subdivisin 4(a) stipulates that: An authrizer may charter a licensed teacher under sectin 122A.18, Subdivisin 1, r a grup f individuals that includes ne r mre licensed teachers under sectin 122A.18, Subdivisin 1, t perate a schl subject t the cmmissiner s apprval f the authrizer s affidavit under paragraph (b). 10

11 New Charter Schl Affidavit Authrizer Assurance and Certificatin Frm 4 NAME OF APPROVED AUTHORIZER: NAME OF NEW CHARTER SCHOOL: Pursuant t Minnesta Statutes, sectin 124D.10, the authrizer assures the cmmissiner f educatin that the authrizing rganizatin will: (initial each line) Ensure that the charter schl s primary purpse is t imprve pupil learning and student achievement per Minnesta Statutes, sectin 124D.10, Subdivisin 1(a). Mnitr the charter schl s cmpliance with all applicable federal, state and lcal laws, rdinances, rules, regulatins and prvisins gverning the peratin f a charter schl in Minnesta shuld the new schl affidavit be apprved by the cmmissiner f the Minnesta Department f Educatin. Arrange a cntract with the schl that meets the prvisins f Minnesta Statutes, sectin 124D.10, Subdivisins 6 and 15(c), including defining the rights and respnsibilities f the charter schl fr gverning its educatinal prgram, cntrlling its funds, and making schl management decisins. Abide by its prcess t be used fr prviding nging versight f the schl cnsistent with the cntract expectatins that assures that the schls chartered are cmplying with bth the prvisins f applicable law and rules, and with the cntract frm the rganizatin s cmmissiner-apprved authrizer applicatin. Fllw its prcess fr making decisins regarding the renewal r terminatin f the charter schl based n evidence that demnstrates the academic, rganizatinal, and financial cmpetency f the schl, including its success in increasing student achievement and meeting the gals f the charter schl agreement frm the rganizatin s cmmissiner-apprved authrizer applicatin. In June f the year prir t pening, alng with the schl s fficial enrllment prjectins, cmplete and submit t the cmmissiner f the Minnesta Department f Educatin the Assurances fr Authrizers relating t leases with sectarian rganizatins and ther matters regarding the accmmdatin f religin in public schls. (Only if affidavit includes an Early Learning Prgram) Prvide versight t preschl and/r prekindergarten instructin and early childhd health and develpmental screening as determined by the cmmissiner f the Minnesta Department f Educatin, and ensure that the charter cntract is amended t include all early learning prgrams ffered by the charter schl. Certificatin: I hereby assure and agree t fully cmply with the abve assurances and all applicable federal, state and lcal laws, rdinances, rules, regulatins and prvisins gverning the authrizatin f a charter schl and will submit dcuments and certificatins as required f apprved authrizers in Minnesta. Authrizer s Identified Official with Authrity (Name, title and signature f persn with legal authrity t certify n behalf f the authrizer.) Name: Signature: Title: Date: 11

12 New Charter Schl Affidavit Schl Assurance and Certificatin Frm 5 NAME OF APPROVED AUTHORIZER: NAME OF NEW CHARTER SCHOOL: Pursuant t Minnesta Statutes, sectin 124D.10, the charter schl assures the cmmissiner f educatin that the charter schl will: (initial each line) Ensure that the charter schl s primary purpse is t imprve pupil learning and student achievement per Minnesta Statutes, sectin 124D.10, Subdivisin 1(a). Cmply with all applicable federal, state and lcal laws, rdinances, rules, regulatins and prvisins gverning the peratin f a charter schl in Minnesta shuld the new schl affidavit be apprved by the cmmissiner f the Minnesta Department f Educatin. If apprved, the applicant will perate the new charter schl accrding t the terms and cnditins f this affidavit and the charter cntract with the schl s authrizer. In June f the year prir t pening, alng with the schl s fficial enrllment prjectins, cmplete and submit t the cmmissiner f the Minnesta Department f Educatin (alng with the amended charter cntract) the Assurances fr Charter Schls relating t leases with sectarian rganizatins and ther matters regarding the accmmdatin f religin in public schls. (Only if affidavit includes an Early Learning Prgram) By July 15 f each year, prvide a yearend reprt t the MDE Divisin f Early Learning Services specifically addressing the prvisin f preschl and/r prekindergarten instructin and early childhd health and develpmental screening as determined by the cmmissiner f the Minnesta Department f Educatin. Certificatin: I hereby assure and agree t fully cmply with the abve assurances and all applicable federal, state and lcal laws, rdinances, rules, regulatins and prvisins gverning the peratin f a charter schl and will submit dcuments and certificatins as required f charter schls in Minnesta. Schl s Identified Official with Authrity (Prvide the name, title and signature f persn with legal authrity t certify n behalf f the new schl, usually the bard chair r lead develper mst likely t becme bard chair.) Name: Signature: Title: Date: 12

13 Authrizer: New Charter Schl Affidavit Review Rubric Charter Schl: Date Affidavit Received: Review Cmpleted: Required Elements Submitted? Prmising Practice The authrizer's fulfillment f this element meets "Satisfactry" criteria and demnstrates a prmising practice f high-quality authrizing. Satisfactry The dcumentatin evidences cmpliance with state law and the authrizer's fulfillment f their cmmissiner-apprved plan. Part A Submissin Eligibility & Affidavit Frms Yes N Rating Unsatisfactry The dcumentatin des nt evidence cmpliance with state law and/r the authrizer's fulfillment f their cmmissiner-apprved plan. A. I Cver Sheet Frm 1 n/a n/a n/a A. II Authrizer Eligibility Certificatin Frm 2 n/a n/a n/a A. III Schl Funders Cntact Infrmatin Frm 3 n/a n/a n/a A.IV Authrizer Assurance and Certificatin Frm 4 n/a n/a n/a A.V Schl Assurance and Certificatin Frm 5 n/a n/a n/a A.VI Ntice t Schl District n/a n/a n/a Part B Terms and Cnditins Yes N Rating B. I Executive Summary B. II Student Perfrmance Expectatins Part C Authrizer Capacity Yes N Rating C.I Capacity & Infrastructure Part D Authrizer s Review Prcess Yes N Rating D. I Review Data, Activities & Analysis Part E Oversight and Cmpliance Yes N Rating E. I Oversight f Perfrmance E. II Cmpliance Satisfactry The dcumentatin evidences cmpliance with criteria guidance fr a high-quality early learning prgram prviding prekindergarten and/r preschl instructin. Part F (OPTIONAL) Early Childhd Prgrams Yes N Rating F.I Cmprehensive Child Assessment F.II Intentinal Instructinal Practice F.III Kindergarten Transitin F.IV Crdinate with Cmmunity-Based Services F.V Staff Ratis and Licensure F.VI Teacher Cntent Knwledge F.VII Early Childhd Screening Unsatisfactry The dcumentatin des nt evidence cmpliance with criteria guidance fr a high-quality early learning prgram prviding prekindergarten and/r preschl instructin.