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Notice of Intent

Please read the Charter Membership Information forms before submitting.

Date*

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Name of applicant:*

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Email Address*

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Street Address*

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City*

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Zip/Postal*

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Phone Number*

Number Required

Name of chartering school district:*

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Name of charter CEO:*

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Name of charter school executive director:*

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Name of special education coordinator:*

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Name of site contact for pupil count information/CBEDS data:*

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Name of site contact responsible for CAESEMIS/other mandated reporting data accuracy:*

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Confirmation Email

Email Required