File: LBD*-E - 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 Board of Education. The intent to apply form may be returned by fax to 719-267-3130 or e-mail to the superintendent of schools. 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: _____________________ Fax: _____________________

E-mail: _____________________________________________________

____________________________________________________________

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 the school district in which this intent to apply form is submitted: [ ] Yes [ ] No, the proposed district charter school will be located in _____________________________________________.

Approved March 22, 2011

Revised March 5, 2013

Reviewed August 21, 2023