TRANSMITTAL FORM School Information Charter School Name: Education Corp. Name: School District (or NYC CSD) of Location: Other districts from which the school is likely to draw students: Days of Instruction Proposed Grades and Affiliations (if any) Enrollment School Grades Total Year Served Enrollment Charter Management 2019-20 Company (“CMO”): 2020-21 2021-22 2022-23 Partner Organization: 2023-24 Contact Information Primary School Contact Name: Title: Mailing Address: Primary Secondary Email: Phone #: #: Primary CMO Contact Name: Primary Secondary Email: #: Phone #: Primary Partner Organization Contact Name: Primary Secondary Email: Phone #: Phone #: Education Corporation Board Chair Signature Submit Completed Application to: Authenticated Digital Signatures accepted. If a handwritten signature is used, the Institute must receive the transmittal form, bearing an original signature, postmarked no later than August 15, 2018. I hereby certify that the information submitted in this Application for Charter SUNY Charter Schools Institute Renewal is true to the best of my knowledge and belief; that the education corporation’s board 41 State St., Suite 700 of trustees has reviewed this application; and, that if awarded a renewal charter, the school Albany, New York 12207 shall operate in a manner consistent with the description outlined in the Application for Charter Renewal. Phone: (518) 445-4250 Fax: (518) 427-6510 Email: Signature: Date: Received OFFICIAL USE Date: ONLY: By:
TRANSMITTAL FORM School Information Charter School Name: Education Corp. Name: School District (or NYC CSD) of Location: Other districts from which the school is likely to draw students: Days of Instruction Proposed Grades and Enrollment Affiliations (if any) School Year Grades Served Total Enrollment Charter Management Company (“CMO”): 2019-20 2020-21 2021-22 Partner Organization: 2022-23 2023-24 Contact Information Primary School Contact Name: Title: Mailing Address: Primary Phone #: Secondary #: Email: Primary CMO Contact Name: Primary #: Secondary Phone #: Email: Primary Partner Organization Contact Name: Primary Phone #: Secondary Phone #: Email: Education Corporation Board Chair Signature Authenticated Digital Signatures accepted. If a handwritten signature is used, the Institute must receive the transmittal form, bearing an original signature, postmarked no later than August 15, 2018. I hereby certify that the information submitted in this Application for Charter Renewal is true to the best of my knowledge and belief; that the education corporation’s board of trustees has reviewed this application; and, that if awarded a renewal charter, the school shall operate in a manner consistent with the description outlined in the Application for Charter Renewal. Submit Completed Application to: SUNY Charter Schools Institute 41 State St., Suite 700 Albany, New York 12207 Phone: (518) 445-4250 Fax: (518) 427-6510 Email: Signature: Date: OFFICIAL USE ONLY: Received By: Date:
2018-19-Renewal-Application-Transmittal-Form.docx