Eligibility Information Information Requested Response Has anyone involved with your charter proposal, whether as staff or a board □ □ YES NO member, ever been convicted of or plead no contest to a felony? Is your organization supported by or affiliated with a religion or religious □ □ YES NO institution? Is your school a conversion of a private school or home study program? □ □ YES NO Is the mission of your school or school organization aligned to serving students □ □ YES NO who are currently served by the lowest performing schools in the State (see ) by opening a new neighborhood option school that prioritizes students served by low-performing schools and/or transforming a low-performing school I certify that all of the information provided in this Notice of Intent is accurate to the best of my knowledge. Lead Applicant Signature: Date:
Eligibility Information Information Requested Response Has anyone involved with your charter proposal, whether as staff or a board member, ever been convicted of or plead no contest to a felony? □ YES □ NO Is your organization supported by or affiliated with a religion or religious institution? □ YES □ NO Is your school a conversion of a private school or home study program? □ YES □ NO Is the mission of your school or school organization aligned to serving students who are currently served by the lowest performing schools in the State (see ) by opening a new neighborhood option school that prioritizes students served by low-performing schools and/or transforming a low-performing school □ YES □ NO I certify that all of the information provided in this Notice of Intent is accurate to the best of my knowledge. Lead Applicant Signature: Date: