File: LBD*-E - Intent to Apply to Become a District Charter School File: LBD*-E - Intent to Apply to Become a District Charter SchoolInstructions: 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 720-506-2912 or e-mail to__________________________________________. The form should also be the first document included in the district charter school application.
Date: ____________________________________
Name of proposed district charter school: ____________________________________________________________________
Name of educational service provider, 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. 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,
4. The proposed district charter school will be located in __________________________________.
Adopted: February 28, 2011
Revised: April 28, 2014