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ATTACHMENT A
OPEN-ENROLLMENT CHARTER CONTRACT RENEW AL PETITION
Current Information in Charter School Tracking System
Charter Holder Name
Charter School Name
Charter School Countyffiistrict
Generation
Maximum Approved Enrollment
Grades Approved
Campuses
072801001 PREMIER HS OF DUBLINCOMANCHEEARLY 112 S GRAFTON ST DUBLIN TX 76446
Grade Levels Currently Served 9101112 072801103 PREMIER HS OF BROWNSVILLE 955 PAREDES LINE ROAD BROWNSVILLE TX 78521
Grade Levels Currently Served 9101112 072801108 PREMIER HS OF FORT WORTH 6411 CAMPBOWIEBLVDSTEB FORT WORTH TX 76116
Grade Levels Currently Served 9101112 072801112 PREMIER HS OF MIDLAND 4320 W ILLINOIS A VENUE MIDLAND TX 79703
Grade Levels Currently Served 9101112
RESPONSNE EDUCATION SOLUTIONS
PREMIER HIGH SCHOOLS
072-80 I
04
I0000
Kl23456789101112
072801101 PREMIER HS OF ABILENE 3161S23RD ST STE 4 ABILENE TX 79605
Grade Levels Currently Served 9101112 072801104 PREMIER HS OF PALMVIEW 406 WEST VETERANS BLVD PALMVIEW TX78572
Grade Levels Currently Served 9101112 072801109 PREMIER HS OF LAREDO 2201 CHIHUAHUA STREET LARDO TX 78043
Grade Levels Currently Served 9101112 072801113 PREMIER HS OF AUSTIN 1701 W BEN WHITE BLVD NO lOOA AUSTIN TX 78704
Grade Levels Currently Served 89101112
072801102 PREMIER HS AT AMERICAN YOUTHWORKS 1901 EAST BEN WHITE BLVD AUSTIN TX 78741
Grade Levels Currently Served 9101112 072801107 PREMIER HS OF DEL RIO 4300EHWY90 DEL RIO TX 78840
Grade Levels Currently Served 9101112 072801110 PREMIER HS OF LUBBOCK 2002 WEST LOOP 289 SUITE 121 LUBBOCK TX 79407
Grade Levels Currently Served 9101112 072801115 PREMIER HS OF PHARR 200 E EXPRESSWAY 83 STE E PHARR TX 78577
Grade Levels Currently Served 9101112
ATTACHMENT A
072801116 PREMIER HS OF MISSION 1203 ST CLAIRE BLVD MISSION TX 78572
Grade Levels Currently Served 9101112 072801121 PREMIER HS OF WACO 4720 NORTH 19m STREET WACO TX 76708
Grade Levels Currently Served 9101112 072801130 PREMIER HS OF SAN JUAN 1202 EAST BUSINESS 83 SAN JUAN TX 78589
Grade Levels Currently Served 9101112 072801136 PREMIER HS OF NEW BRAUNFELS 1928 S SEGUINE A VE UNIT IOOA NEW BRAUNFELS TX 78130
Grade Levels Currently Served 9101112 072801139 PREMIER HS OF SOUTH IRVING 108I WEST SHADY GROVE ROAD IRVING TX 75060
Grade Levels Currently Served 9101112 072801142 PREMIER HS OF AMARILLO 3242 HOBBS ROAD AMARILLO TX 792278
Grade Levels Currently Served
Geographical Boundary
072801117 PREMIER HS OF SAN ANTONIO 502 EAST RAMSEY ROAD SAN ANTONIO TX 78216
Grade Levels Currently Served 9101112 072801128 PREMIER HS OF NORTH AUSTIN 1835-A KRAMER LANE SUITE 600 AUSTIN TX 78758
Grade Levels Currently Served 9101112 072801131 PREMIER HS OF RICHARDSON 1111 DIGITAL DRIVE RICHARDSON TX 75081
Grade Levels Currently Served 9 101112 072801137 PREMIER HS OF GRANBURY 919 EAST HIGHWAY 377 SUITE 1 GRANBURY TX 76048
Grade Levels Currently Served 910l lI2 072801140 PREMIER HS OF WEST IRVING 134I ROYAL LANE DFW AIRPORT TX 75261
Grade Levels Currently Served 11 12
072801118 PREMIER HS OF TYLER 1106 NORTH GLENWOOD BLVD TYLER TX 75702
Grade Levels Currently Served 9101112 072801129 PREMIER HS OF EL PASO 1035 BELVEDERE SUITE 116 EL PASO TX 79912
Grade Levels Currently Served 9101112 072801135 PREMIER HS OF HUNTSVILLE 2407 SAM HOUSTON AVE SUITE C HUNTSVILLE TX 77340
Grade Levels Currently Served 9101112 072801138 PREMIER HS OF DAYTON 1707 COUNTY ROAD 611 DAYTON TX 77535
Grade Levels Currently Served 9I01112 072801141 PREMIER HS OF LEWISVILLE 1800 LAKEWAY DRIVE 120 LEWISVILLE TX 75057
Grade Levels Currently Served 9101 I12
The original charter application and amendment history reflects that the following district(s) comprise the charter schools geographic boundary
ABILENEISD ANGLETON ISD AXTELLISD BIRDVILLE SD ACADEMYISD ANNAISD AZLEISD BISHOPCISD AGUA DULCE SD ANSONISD BAIRDISD BLANCOISD ALAMO HEIGHTS ISD ANTHONYISD BANDERAISD BLANDISD ALBA-GOLDEN ISD APPLE SPRINGS ISD BANGSISD BLANKETISD ALDINEISD AQUILLA ISD BANQUETE ISD BLOOMBURG SD ALEDOISD ARANSASCOUNTYISD BARBERS HILL ISD BLUFF DALE ISD ALICE ISD ARANSAS PASS ISD BARTLETT ISD BOERNEISD ALIEF ISD ARCHER CITY ISD BASTROPISD BONHAMISD ALLENISD ARGYLEISD BAYCITYISD BORGERISD ALVARADO ISD ARLINGTON ISD BEAUMONT SD BOSQUEVILLE SD ALVINISD ATHENSISD BEEVILLE ISD BOWIEISD AMARILLO ISD ATLANTAISD BELLEVUE SD BRADYISD ANAHUACISD AUBREYISD BELLVILLE SD BRAZOSISD ANDERSON-SHIRO CISD AUSTIN ISD BELTONISD BRAZOSPORT ISD ANDREWS ISD AVALONISD BIG SPRING ISD BRECKENRIDGE SD
BRENHAM ISO BRIDGE CITY ISO BRIDGEPORT ISO BROCKISD BROOKELAND ISO BROOKESMITH ISO BROOKS COUNTY ISO BROWNFIELD ISO BROWNSBORO ISO BROWNSVILLE ISO BROWNWOOD ISO BRUCEVILLE-EDDY JSD BRYAN ISO BULLARD ISO BUNAISD BURKBURNETT ISO BURKEVILLE ISO BURLESON SD BURNETCISD BURTON ISO BUSHLAND ISO CADDO MILLS ISO CALALLEN JSD CALDWELL ISO CALHOUN COUNTY ISO CAMERON ISO CANTON ISO CANUTJLLO ISO CANYON ISO CARLISLE ISO CARRIZO SPRINGS CISD CARROLL ISO CARROLLTON-FARMERS BRANCH ISO CARTHAGE SD CASTLEBERRY JSD CEDAR HILL SD CELINA ISO CENTERVILLE SD CENTERVILLE ISO CHANNELVIEW JSD CHANNING ISO CHAPEL HILL ISO CHAPEL HILL SD CHILDRESS SD CHILTONSD CHINA SPRING ISO CHISUM ISO CHRJSTOVAL ISO CITY VIEW SD CLEAR CREEK ISO CLEBURNE SD CLEVELAND SD CLINTJSD CLYDECISD COLDSPRING-OAKHURST CISD COLLEGE STATION SD COLMESNEIL SD COLORADO ISO COLUMBIA-BRAZORIA ISO COMALISD COMANCHE SD COMFORT ISO COMMERCE ISO COMMUNITY ISO COMSTOCK ISO CONNALLY SD CONROESD COPPELLJSD COPPERAS COVE SD CORPUS CHRISTI ISO CORRJGAN-CAMDENISD CORSICANA ISO COTULLA ISO COUPLAND ISO CRANDALL SD CRAWFORD JSD
CROCKETT SD CROSBY ISO CROWLEY ISO CRYSTAL CITY ISO CYPRESS-FAIRBANKS SD DAINGERFIELD- LONE STAR ISO DALHART ISO DALLAS ISO DAMONISD DANBURY ISO DAYTONSD DELEON ISO DECATUR ISO DEER PARK ISD DEKALB ISO DELVALLE SD DENISON ISO DENTON ISO DENVER CITY ISO DESOTO ISO DEVERS ISO DEVINESD DICKINSON ISO DIMMITTISD DONNA ISO DRIPPING SPRINGS ISO DRISCOLL SD DUBLIN SD DUMASISD DUNCANVILLE ISO EAGLE MT-SAGINAW ISO EAGLE PASS JSD EANES SD EARLY ISO EAST CENTRAL ISO EAST CHAMBERS ISO EASTLAND SD ECTOR COUNTY SD EDCOUCH-ELSA SD EDGEWOOD SD EDGEWOOD SD EDINBURG CSD EL PASO ISO ELECTRA ISO ELGINISD ELKHARTJSD ENNIS ISO ETOLEISD EULAISD EVADALEISD EVERMAN ISO EZZELL ISO FABENSISD FAIRFIELD ISD FARMERSVILLE SD FERRIS ISO FLORENCE SD FLORESVILLE SD FLOUR BLUFF SD FORNEY ISO FORSAN ISO FORT BEND SD FORT STOCKTON SD FORT WORTH SD FRANKLIN ISO FRANKSTON SD FREDERICKSBURG ISO FRENSHil ISO FRIENDSWOOD ISO FRJONAISD FRISCOISD FT SAM HOUSTON ISO GAINESVILLE SD GALENA PARK SD GALVESTON SD GARLAND ISO GATESVILLE SD
GEORGE WEST SD GEORGETOWN SD GIDDINGS SD GLADEWATER ISO GLEN ROSE SD GODLEY ISO GOLDTHWAITE ISO GONZALES ISO GOOSE CREEK CISD GRAHAMJSD GRANBURY ISO GRAND PRAIRIE SD GRAND SALINE SD GRANDVIEW ISO GRANGER ISO GRAPE CREEK SD GRAPEVINE-COLLEYVILLE SD GREENVILLE ISO GREENWOOD SD GREGORY -PORTLAND SD GROESBECK ISO GROVETON SD GUSTINE ISO HALLSVILLE SD HAMILTON ISO HAMSHIRE-FANNETT ISO HARDIN ISO HARDIN-JEFFERSON ISO HARLANDALE SD HARLINGEN CISD HARROLDISD HAWKINS ISO HAWLEYISD HAYSCISD HEMPHILL SD HEMPSTEAD ISO HENDERSON ISO HENRJETTA ISO HEREFORD ISO HICOISD HIDALGO ISO HIGH ISLAND SD HIGHLAND PARK JSD HIGHLAND PARK ISO HILLSBORO ISO HITCHCOCK ISO HOLLAND ISO HOLLIDAY ISO HONDOISD HOUSTON ISO HUCKABAY ISO HUFFMAN ISO HULL-DAISETTA ISO HUMBLE ISO HUNTSVILLE SD HURST-EULESS-BEDFORD SD HUTTOISD IDALOU ISO INGLESIDE SD INGRAM ISO IOWAPARKCISD IRVINGISD ITALY SD JACKSONVILLE SD JARRELLJSD JASPER ISO JIM HOGG COUNTY SD JIM NED CSD JOSHUA ISO JOURDANTON ISO JUDSONISD KATYISD KAUFMAN ISO KEENEISD KELLER ISO KEMPJSD KENNEDALE ISO
ATTACHMENT A
KERMITISD KERRVILLE SD KJLGOREISD KILLEEN SD KINGSVILLE ISO KIRBYVILLE CJSD KLEINISD KNilPA ISO KOUNTZE ISO KRUMISD LAFERJAJSD LA GRANGE ISO LAJOYAISD LA MARQUE SD LAPORTE ISO LA VEGAISD LA VERNIA SD LA VJLLAISD LACKLAND ISO LAGO VISTA SD LAKE DALLAS JSD LAKE TRAVIS JSD LAKE WORTH SD LAMARCISD LAMESAISD LAMPASAS ISO LANCASTER ISO LAREDO ISO LASARAISD LATEXOISD LEANDERISD LEVELLAND ISO LEWISVILLE ISO LIBERTY HILL ISO LWERTYISD LWERTY-EYLAU ISO LINDALE ISO LINGLEVILLE ISO LIPANISD LITTLE CYPRESS-MAURICEVILLE CJSD LITTLE ELM ISO LITTLEFIELD ISD LIVINGSTON ISO LLANOISD LOCKHART ISD LONDON ISO LONGVIEW ISO LORENA ISO LOS FRESNOS CISD LOVEJOY ISO LOVELADY ISO LUBBOCK ISO LUBBOCK-COOPER ISO LUFKIN ISO LULING ISO LUMBERTON JSD LYFORDCISD LYTLE ISO MABANK ISO MADISONVILLE CISD MAGNOLIA ISO MANORISD MANSFIELD ISO MARBLE FALLS ISO MARlONISD MARLIN ISO MARSHALL ISO MARTISD MATAGORDA ISO MATHIS ISO MAY ISO MAYPEARL ISO MCALLEN ISO MCGREGOR ISO MCKINNEY SD MCLEOD ISO
MEDINA VALLEY SD MELISSASD MERCEDES SD MERKELISD MESQUITE ISO MEXIAISD MEYERSVILLE ISO MIDLAND ISO MIDLOTHIAN ISO MIDWAY ISO MIDWAY ISO MILES SD MILFORD ISO MINEOLAISD MINERAL WELLS ISO MISSION CISD MONAHANS-WICKETI-PYOTE SD MONTE ALTO ISO MONTGOMERY ISO MOODY ISO MORGAN MILL ISO MOUNT PLEASANT SD MOUNT VERNON ISO MULESHOE SD NACOGDOCHES ISO NATALIA ISO NAVARRO ISO NAVASOTA SD NEDERLAND ISO NEEDVILLE ISO NEW BOSTON ISO NEW BRAUNFELS SD NEW CANEY SD NEW DEAL ISO NEW WAVERLY ISO NEWTON ISO NIXON-SMILEY CISD NORTH EAST ISO NORTH FOREST ISO NORTH LAMAR ISO NORTHSIDE ISO NORTHWEST ISO ODEM -EDROY ISO OGLESBY ISO OLNEY ISO ONALASKA ISO ORANGE GROVE ISO ORANGEFIELD ISO OVERTON ISO PALACIOS ISO PALESTINE ISO PALMER ISO PAMPA ISO PARIS ISO PASADENA ISO PEARLAND SD PEARSALL ISO PEASTERISD
PECOS-BARSTOW-TOYAH ISO PERRYTON ISO PETERSBURG ISO PETROLIA CISD PEWITTCISD PFLUGERVILLE ISO PHARR-SAN JUAN-ALAMOISD PILOT POINT ISO PINE TREE ISO PITTSBURG ISO PLAINVIEW ISO PLANO ISO PLEASANT GROVE ISO PLEASANTON SD POINT ISABEL ISO PONDER ISO POOLVILLE ISO PORT ARANSAS ISO PORT ARTHUR ISO PORT NECHES-GROVES ISO POTEET ISO POTISBORO ISO PRAJRILAND ISO PRESIDIO ISO PRINCETON ISO PROGRESO ISO PROSPER ISO QUINLAN ISO RANDOLPH FIELD SD RAYMONDVILLE ISO REDOAKISD REDWATER ISO RICHARDS ISO RICHARDSON ISO RIESEL ISO RIO GRANDE CITY CISD RlO HONDO ISO RlO VISTA ISO RJVER ROAD SD RJVERCREST ISO RIVIERA ISO ROBINSON ISO ROBSTOWN ISO ROCKDALE ISO ROCKWALL SD ROGERSISD ROMA ISO ROOSEVELTISO ROPES ISO ROSCOE COLLEGIATE SD ROUND ROCK SD ROXTON ISO ROYAL ISO ROYSE CITY SD RUSKISD SABINE PASS ISO SALADOISD SAN ANGELO ISO SAN ANTONIO ISO
SAN BENITO CISD SAN DIEGO ISO SAN ELIZARIO ISD SAN FELIPE-DEL RIO CISD SAN ISIDRO ISO SAN MARCOS CJSD SANGER ISO SANTA FE ISO SANTA MARIA ISO SANTA ROSA ISO SCHERTZ-ClBOLO-U CITY ISO SCURRY -ROSSER ISO SEALY ISO SEGUINISD SEMINOLE ISO SEYMOUR ISO SHALLOWATER ISO SHARYLAND ISO SHELDON ISO SHEPHERD ISO SHERMAN ISO SIDNEY ISO SILSBEE ISO SINTON ISO SLATON ISO SMITHVILLE SD SMYER ISO SNYDER ISO SOCORRO ISO SOMERSET SD SOUTH SAN ANTONIO ISO SOJTIJ TEXAS ISD SOUTHSIDE ISO SOUTHWEST SD SPLENDORA ISO SPRING BRANCH ISO SPRJNGISD SPRINGTOWN ISO SPURGER ISO STAFFORD MSD STAMFORD ISO STANTONISD STEPHENVILLE SD SULPHUR BLUFF ISO SULPHUR SPRlNGS ISO SUNNYVALE SD SWEENY ISO SWEETWATER ISO TAFTISD TAHOKAISD TARKINGTON ISD TAYLOR ISO TEAGUE ISO TEMPLEISD TERLINGUA CSD TERRELL COUNTY ISO TERRELLISD TEXARKANA ISO TEXAS CITY ISO
ATTACHMENT A
THRALLISD THREE WAY ISO TIDEHAVEN ISO TOLARISD TOM BEAN ISO TOMBALL ISO TORNJLLO SD TRENTISD TRINITY ISO TROUP ISO TROY ISO TULOSO-MIDWAY SD TYLERISD UNITEDISD UVALDECISD VALLEY MILLS ISO VALLEY VIEW ISO VALLEY VIEW SD VAN ALSTYNE ISO VAN ISO VAN VLECK SD VENUSISD VERlBEST ISO VERNONISD VICTORIA ISO VIDORISD VYSEHRAD ISO WACO ISO WALL ISO WALLERISD WARREN ISO WATER VALLEY ISO WAXAHACHIE ISO WEATHERFORD SD WESLACOISD WESTISD WEST ORANGE-COVE CISD WESTOSOISD WEST RUSK COUNTY CONSOLIDATED ISO WEST SABINE ISO WHITE SETILEMENT ISO WHITEHOUSE SD WHITESBORO ISO WHITNEY ISO WICHIT A FALLS ISO WILDORADO SD WILLIS ISO WILLS POINT SD WILSONISD WIMBERLEY ISO WINDTHORST SD WJNONAISD WOODVILLE ISO WYLIEISD WYLIE ISO YSLETAISD ZAPATA COUNTY ISO ZEPHYRISD
Table of Contents
Explanation of Renewal Process 4
Application Instructions 5
Selected Definitions 6
Application Sections
Section I Coversheet (Attachment A) 7 This is a printout of current charter holder information from the TEA Division of Charter School Administration database the CSTS and must be attached as the application coversheet (Attachment A)
Section II Contact Information 8 Requires the charter holder to provide the current contact information for the superintendent the charter holder board chair and the person who prepared the application
Section III Website Postings 9 Requires the charter holder to provide the homepage web address where the names of the members of the governing body are listed the web address where the superintendents salary is posted and web address where the charter financial statements are continuously posted as required by Local Government Code sect140006
Section IV Organizational Charts 10 Requires the charter holder to provide the organizational chart of the charter school as well as a chart showing other entities and programs managed by the charter holder This section requires the submission of attachments 1and 2
Section V Admission Policy 11 Requires the charter holder to provide details concerning the charter schools admission policy and practices In addition this section requires the submission of attachments 3 4 and 5
Section VI Special Education Assurances 14 Requires the charter holder to certify that it has policies and procedures in place that ensure implementation ofall federal Jaws and regulations Texas laws State Board of Education rules and commissioner rules related to students with disabilities and further assures that any future amendments to the regulations Jaws and rules will be incorporated and implemented This section must be signed by the charter holder board chair
Section VII Serving Students at Residential Facilities Assurances 15 This section is required only when the charter educates students at a residential facility Requires the charter holder to certify that it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education rules and commissioner rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the Jaws regulations and rules will be incorporated and implemented If required this section must be signed by the charter holder board chair
Section VIII BilingualESL Section 504 and Dyslexia Assurances 17 Requires the charter holder to certify that it has policies and procedures in place ensuring that it complies with the legal and regulatory requirements concerning identifying and providing appropriate education services to limited English proficient students students protected by Section 504 of the Rehabilitation Act of 1973 and students with dyslexia or related disorders This section must be completed and signed by the charter holder board chair
Page 2
Section IX Fingerprinting and Criminal Record Check Assurance 18 Requires the charter holder to certify that it is in compliance with TEC sect 12120 and confirms that no individual is serving in any capacity ifhe or she has been convicted ofa misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code of Criminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Section X Certificate of Acknowledgement 19 Requires at least a majority of the governing body of the charter holder to certify that it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of the renewal of the charter
Texas Education Agency Contact Information 20
Renewal Process Flowchart 21
Attachments Required of Applicant
Charter School Organizational Chart (Attachment I)
Charter Holder Organizational Chart (Attachment 2)
Admission Policy (Attachment 3)
Admission Application (Attachment 4)
Enrollment Form (Attachment 5)
Pagc3
Explanation of Renewal Process
19 Texas Administrative Code (TAC) sectI 00 103J contains additional information about charter renewal
The renewal process is separate from the charter amendment process Significant changes from the original charter should not be made in the renewal application unless a charter amendment has been previously approved
As authorized in Texas Education Code (TEC) sect121141 the commissioners procedures for renewal must include three distinct processes expedited renewal discretionary renewal and expiration
Definitions of the three renewal processes
Expedited (30 days) If in the preceding 3 years bull Highest or second highest academic performance rating bull Satisfactory or higher financial rating and bull No campus has been assigned the lowest rating or no campus has been closed for low ratings
Discretionary (90 days) Consideration among others of bullAcademic Performance 2009-2010 2010-2011 2012-2013 2013-2014 bull Financial Ratings 2009-2010 20I0-2011 2011-2012 2012-2013 2013-2014 bullPerformance Framework (TEC sect121181)
Expiration (30 day notification) If for any 3 of the 5 preceding school years bull Lowest academic performance rating bull Lower than satisfactory financial rating bull The charter was assigned any combination of ratings or bull A campus has been assigned the lowest performance rating for the 3 preceding school years and has not been closed
The due date for charters to submit the completed renewal application to the Texas Education Agency (TEA) is Wednesday January 7 2015
You may request an informal review of the findings and actions described in this letter by sending a written request to
Brandon Spenrath Program Specialist Charter School Administration Texas Education Agency 170 I North Congress Ave Austin Texas 7870 I Fax (512) 936-9281 brand on spen rat h(iitea state tx us
The request must be received no later than Wednesday December 17 2014 Your request must identify what changes you are requesting the reasons for your request and documentation to support your request If we do not receive your request before the deadline final action will be taken without further review
Please see 19 TAC Chapter 157 subchapter EE Division I for addition information about the informal review process
Pagc4
Application Instructions
The renewal application contains ten sections to be completed electronically printed into hardcopy form for required signatures and dates and submitted on or before the due date to the Division ofCharter School Administration
1 Deadline The completed application must be returned by mail to the Division ofCharter School Administration by Wednesday January 7 2015
2 Typing Requirement All of the responses to the application sections with the exception ofsignatures and dates of signatures must be typed
3 Printing Requirement The application must be printed on one-sided 8 I 2 x 11 white paper
4 Signature Requirement Where signatures and dates ofsignatures are required they must be in blue ink
5 Submission of Original Document and One Copy The completed and unbound (rubber bands or clips are acceptable) original renewal application including fillable forms and attachments and one additional copy must be submitted as follows
Texas Education Agency Division ofCharter School Administration
170 I North Congress A venue Austin Texas 7870 I
Page 5
Selected Definitions
Please review TEC sect12 I OJ 2 and 19 TAC sect1001001 for definitions of terms which are available at the education laws and mies page Listed below are selected terms and definitions
bull Charter holder - the entity to which a charter is granted under TEC Chapter 12
bull Charter school - a Texas public school operated by a charter holder under an open-enrollment charter granted by the commissioner n pursuant to TEC sect12 J01
Governing body ofa charter holder - the board of directors board of tmstees or other governing body of a charter holder
bull Governing body ofa charter school - the board of directors board of trustees or other governing body of an open-enrollment charter school the term includes the governing body ofa charter holder ifthat body acts as the governing body of the open-enrollment charter school
bull Management company - a person or entity other than a charter holder that provides management services for an open-enrollment charter school
bull Officer ofa charter school - the principal director or other chief operating officer of an open-enrollment charter school an assistant principal or assistant director of an open-enrollment charter school or a person charged with managing the finances ofan open-enrollment charter school
bull Board chair or chaitperson - generally the board president or presiding officer of the governing board
Page 6
Section I
Coversheet
ATTACHMENT A OPEN-ENROLLMENT CHARTER CONTRACT RENEWAL
The enclosed document entitled OPEN-ENROLLMENT CHARTER CONTRACT RENEW AL will serve as the coversheet when the application is completed and submitted and includes current information in the Charter School Tracking System Verify the accuracy of the information on the coversheet and if updates to the information are needed create a separate sheet detailing your corrections and label the sheet Update to Data Provided by TEA and include it in the renewal packet immediately following the preprinted coversheet
Pagc7
Section II
Contact Information
The persons listed below will be contacted by agency staff ifthere are issues to be resolved in any ofthe renewal application sections Note that any contact information including email addresses provided with the renewal application will be public information
Superintendent Contact Information
Superintendents Name lcharles Cook
=============================================== Telephone Number 1(972) 316-3663
=============================================== Fax Number 1972-315-9506
=========================================~ E-mail Address lccookresponsiveedcom
Charter Holder Board Chair Contact Information
Board Chairs Name Marvin Reynolds
Telephone Number 1866-605-7772
Fax Number 1972-315-9506
E-mail Address leducatenationalhomeschoolcom
Application Preparers Contact Information El Same as Superintendent D Same as Board Chair
Contact Name lcharles Cook
Telephone Number 1(972) 316-3663
Fax Number 1972-315-9506
E-mail Address lccookresponsiveedcom
Charter School Website
Web address lhttppremierhighschoolscom
Page 8
Section III
Website Postings
In accordance with the requirements of TEC sect12 1211 an open-enrollment charter school shall list the names of the members of the governing body on the home page of the schools internet website Provide the internet URL address where the names of the members of the governing body are listed
httppremierhighschoolscomtexas-state-requi red-information
In accordance with the requirements of TEC sect12 136 an open-enrollment charter school shall post the salary of the schools superintendent or CEO on the schools internet website Provide the internet URL address where the superintendents salary is posted
httppremierhighschoolscomtexas-state-required-information
In accordance with Local Government Code sect140006 an open-enrollment charter school shall post continuously on the schools internet website the annual financials of the school Provide the internet URL address where the annual financial statements of the charter school are continuously posted
httppremierhighschoolscomtexas-state-required-information
Page9
Section IV
Organizational Charts
Submit as Attachment 1 the organizational chart for the charter school that specifies the administrative positions including the title and name of the individual currently in each position
Submit as Attachment 2 a chart that identifies all other entities under the direction of the charter holder This would include entities andor programs that the charter holder governsmanages in addition to the charter school
Page 10
I I
I I
I
middot~middot==middot==middotmiddotmiddotmiddot~~ Robert Davison liChief Operating O~cj
~1~ middotmiddotmiddotmiddotmiddotmiddot shyOr Mary Ann Duncan Gary Arnold Corey Thomas
VP-School VP - Human InformationI Operations I Resources Technology (IT)
--~~1~-- ---~~~
middotmiddotmiddotmiddotmiddotmiddot-middot -middot~ ----- shy
Kim OLeary PEIMS
ResponsiveEdPremier High Schools
Board of Directors
Chuck Cook Superintendent I
Chief Executive Officer
I Chris eaumaOn bull
General Counsel IVP - Business Oevelooment I
I ~--------1~ -middotmiddotmiddotmiddotmiddot ~ I
Jeffrie Evans Terri Baumann Brian Stevens carrie Alexander
Marketing amp Curriculum Facilities VP - Finance
Communications Development
I I
Regional Directors of Regional Directors of Operations Academics
campus Directors shyPremier High School shy
Premier High School Campus Staff
I
Or Alan Wimberley Chief Education
Architect
I I
Wesley Cockrum I=Software Kyle Queal
Development - Academics -----I_____
I
I
Responsive Education bullt--------------------------iI R~~~i~~=~~~~=~1Solutions
=~~~~~ I
1rmiddot~middot=middotmiddotmiddot=middot~-~--~middot-I Texas Education
Texas Education Indianapolis MayorsAustin Independent llAgency- Texas College Ohio Council ofd~~Amiddotdcp_p1 [~~
I
Agency- Premier High Office of EducationSchool District - 2 Preparatory Community Schools I State Board of Schools Charter Innovation - 1 School
Sites Academies Charter -5 Schoolsf roved I II Education -4 Charters District - 32 Sites ApprovedI District - 33 Sites Approved
l_ I n=li=middot
I ===-middotmiddot--middot
Section V
Admission Policy
Pie e be aware that any change to the terms ofan open-enrollment charter that relates to the following subjects
ade levels bullma middotmum enrollment
hie boundaries bullapprove ampus(es) bull approved s s bull relocation of bull charter holder n e bullcharter school (dis ct) name bull charter campus name bullcharter holder goveman bull articles of incorporation bull corporate bylaws bullmanagement company bull admission policy or bull the educational program of the sch
requires the commissioner ofeducations approva fan amendment (See sectI00 1033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admis middot n are accepted TEC sectI2117 requires that a charter school establish a reasonable application deadline for the 1bmission ofapplications for admission
Beginning of Period (MonthDay)
May4 2015
B If the school admits students by lottery when the number of admissions ap middotcations received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Not applicable
C If the school utilizes a lottery when oversubscribed are any categories ofapplicants exempted from th lottery
0Ycs
0No
0 Not applicable (because lotteries arc not utilized)
If Yes was indicated in C above state the categories ofapplicants that are exempted
Page 11
Section V
Admission Policy
Please be aware that any change to the terms of an open-enrollment charter that relates to the following subjects
bull grade levels bullmaximum enrollment bull geographic boundaries bullapproved campus(es) bull approved sites bull relocation of campus bull charter holdername bull charter school (district) name bull charter campus name bull charter holder governance bull articles of incorporation bullcorporate bylaws bull management company bull admission policy or bullthe educational program of the school
requires the commissioner of educations approval ofan amendment (See sect1001033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadline for the submission ofapplicationsfor admission
Beginning ofPeriod (MonthDay) End of Period (MonthDay)
--~~~-M-ay_4__2_01_s~~~--I l__~~~M_a_y_1_a_2_0_1s~~~---
B If the school admits students by lottery when the number of admissions applications received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Aname (or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) Is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order in which they were drawn Notification of admission will be made and failure of a parent to respond within 48 hours of notification will forfeit his or her position in the lottery
C lfthe school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
0Yes
ONo
0 Not applicable (because lotteries are not utilized)
IfYes was indicated in C above state the categories of annlicants that are exempted
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Page 11
Section V (Continued)
Admission Policy
e school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be con led
Approximate Date of Lottery (MonthDay) ceuroSS ~ ~l-0
NA coll11lGeurolc
0ull-1lG E If the school does not utilize ottery when oversubscribed bu lleuroJSeuro~euroll-l ctole positions in the order in which
applications were received befo the expiration of the applicatil seuroeuro l 11e a first-come first-served admission process) describe the manner in ich the school notifies the ct bull 11unity of the opportunity to apply for admission TEC sect12 117 requires a charter sc of that uses ajirst-comefirst-served admission process when ove1mbscribed to publish a notice in a newspaper ofge1 ral circulation not later than the seventh day before the application deadline
Advertisements are published in the local newspap notifying the community of the Open-Enrollment Period for the school at least seven days before the close of the Ope Enrollment Period
F lfthe school has a separate process for re-enrollment state e process and the timeline to be used
he Re-Enrollment Period will begin May 4 2015 and end May 14 2 15 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 15 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the ignated window as listed above Students who could continue at their current campus but wish to transfer to a different mier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and o in a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application dea ine has passed
If an Application is received from an eligible applicant after the close of the open-enrollment p iod the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely ap ied
H Describe the infom1ation that an applicant must provide in order to be considered for admission Appi ants may not be required to provide copies of transcripts or other academic records until after they are offered od1 middotsion and are enrolling Furthermore a student may not be precluded ji-om enrolling due to the charter schools fail e to receive biformation required for enrollment ji-om the students parent or guardian or previous school See TEC sect2 002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date ofLottery (MonthDay)
0520 APPROVED DURING CONTINGENCY PROCESS
E If the school does not utilize a lottery when oversubscribed but rather fills the available positions in the order in which applications were received before the expiration ofthe application deadline (ie a first-come first-served admission process) describe the manner in which the school notifies the community of the opportunity to apply for admission TEC sect12117 requires a charter school that uses a first-come first-served admission process when oversubscribed to publish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
NIA
F If the school has a separate process for re-enrollment state the process and the timeline to be used
lfhe Re-Enrollment Period will begin May 4 2015 and end May 14 2015 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 2015 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the designated window as listed above Students who could continue at their current campus but wish to transfer to a different Premier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and obtain a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application deadline has passed
If an Application Is received from an eligible applicant after the close of the open-enrollment period the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
H Describe the information that an applicant must provide in order to be considered for admission Applicants may not be required to provide copies of transcripts or other academic records until after they are offered admission and are enrolling Furthermore a student may not be precluded from enrolling due to the charter schools failure to receive information required for enrollment from the students parent or guardian or previous school See TEC sect25002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
I The charter holder certifies that the non-discrimination statement required by TEC sectI2 I I I (a)(5) is printed in the schools admission policy TEC sect121 I I (a)(5) requires that a charter schools admission policy include a statement that the school will not discriminate in admissions based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend
0Ycs
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories ofa criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 3 7 Subchapter A as authorized by TEC sectI21 II (a)(5)(B)
0 Yes (The school excludes such students or reserves the right to exclude such students from admissions)
0 No (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bullA current copy of the admission policy that incorporates the information provided in the above answers to questions
A through H and any other relevant information (Attachment 3)
bull A blank copy of the current admission application ie the information requested when the student first seeks
admission (Attachment 4) and
bullA blank copy of the current enrollment form(s) ie the information required once an applicant has been offered
admission and is registering for enrollment (Attachment 5)
Page 13
I I
i
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
ATTACHMENT A
072801116 PREMIER HS OF MISSION 1203 ST CLAIRE BLVD MISSION TX 78572
Grade Levels Currently Served 9101112 072801121 PREMIER HS OF WACO 4720 NORTH 19m STREET WACO TX 76708
Grade Levels Currently Served 9101112 072801130 PREMIER HS OF SAN JUAN 1202 EAST BUSINESS 83 SAN JUAN TX 78589
Grade Levels Currently Served 9101112 072801136 PREMIER HS OF NEW BRAUNFELS 1928 S SEGUINE A VE UNIT IOOA NEW BRAUNFELS TX 78130
Grade Levels Currently Served 9101112 072801139 PREMIER HS OF SOUTH IRVING 108I WEST SHADY GROVE ROAD IRVING TX 75060
Grade Levels Currently Served 9101112 072801142 PREMIER HS OF AMARILLO 3242 HOBBS ROAD AMARILLO TX 792278
Grade Levels Currently Served
Geographical Boundary
072801117 PREMIER HS OF SAN ANTONIO 502 EAST RAMSEY ROAD SAN ANTONIO TX 78216
Grade Levels Currently Served 9101112 072801128 PREMIER HS OF NORTH AUSTIN 1835-A KRAMER LANE SUITE 600 AUSTIN TX 78758
Grade Levels Currently Served 9101112 072801131 PREMIER HS OF RICHARDSON 1111 DIGITAL DRIVE RICHARDSON TX 75081
Grade Levels Currently Served 9 101112 072801137 PREMIER HS OF GRANBURY 919 EAST HIGHWAY 377 SUITE 1 GRANBURY TX 76048
Grade Levels Currently Served 910l lI2 072801140 PREMIER HS OF WEST IRVING 134I ROYAL LANE DFW AIRPORT TX 75261
Grade Levels Currently Served 11 12
072801118 PREMIER HS OF TYLER 1106 NORTH GLENWOOD BLVD TYLER TX 75702
Grade Levels Currently Served 9101112 072801129 PREMIER HS OF EL PASO 1035 BELVEDERE SUITE 116 EL PASO TX 79912
Grade Levels Currently Served 9101112 072801135 PREMIER HS OF HUNTSVILLE 2407 SAM HOUSTON AVE SUITE C HUNTSVILLE TX 77340
Grade Levels Currently Served 9101112 072801138 PREMIER HS OF DAYTON 1707 COUNTY ROAD 611 DAYTON TX 77535
Grade Levels Currently Served 9I01112 072801141 PREMIER HS OF LEWISVILLE 1800 LAKEWAY DRIVE 120 LEWISVILLE TX 75057
Grade Levels Currently Served 9101 I12
The original charter application and amendment history reflects that the following district(s) comprise the charter schools geographic boundary
ABILENEISD ANGLETON ISD AXTELLISD BIRDVILLE SD ACADEMYISD ANNAISD AZLEISD BISHOPCISD AGUA DULCE SD ANSONISD BAIRDISD BLANCOISD ALAMO HEIGHTS ISD ANTHONYISD BANDERAISD BLANDISD ALBA-GOLDEN ISD APPLE SPRINGS ISD BANGSISD BLANKETISD ALDINEISD AQUILLA ISD BANQUETE ISD BLOOMBURG SD ALEDOISD ARANSASCOUNTYISD BARBERS HILL ISD BLUFF DALE ISD ALICE ISD ARANSAS PASS ISD BARTLETT ISD BOERNEISD ALIEF ISD ARCHER CITY ISD BASTROPISD BONHAMISD ALLENISD ARGYLEISD BAYCITYISD BORGERISD ALVARADO ISD ARLINGTON ISD BEAUMONT SD BOSQUEVILLE SD ALVINISD ATHENSISD BEEVILLE ISD BOWIEISD AMARILLO ISD ATLANTAISD BELLEVUE SD BRADYISD ANAHUACISD AUBREYISD BELLVILLE SD BRAZOSISD ANDERSON-SHIRO CISD AUSTIN ISD BELTONISD BRAZOSPORT ISD ANDREWS ISD AVALONISD BIG SPRING ISD BRECKENRIDGE SD
BRENHAM ISO BRIDGE CITY ISO BRIDGEPORT ISO BROCKISD BROOKELAND ISO BROOKESMITH ISO BROOKS COUNTY ISO BROWNFIELD ISO BROWNSBORO ISO BROWNSVILLE ISO BROWNWOOD ISO BRUCEVILLE-EDDY JSD BRYAN ISO BULLARD ISO BUNAISD BURKBURNETT ISO BURKEVILLE ISO BURLESON SD BURNETCISD BURTON ISO BUSHLAND ISO CADDO MILLS ISO CALALLEN JSD CALDWELL ISO CALHOUN COUNTY ISO CAMERON ISO CANTON ISO CANUTJLLO ISO CANYON ISO CARLISLE ISO CARRIZO SPRINGS CISD CARROLL ISO CARROLLTON-FARMERS BRANCH ISO CARTHAGE SD CASTLEBERRY JSD CEDAR HILL SD CELINA ISO CENTERVILLE SD CENTERVILLE ISO CHANNELVIEW JSD CHANNING ISO CHAPEL HILL ISO CHAPEL HILL SD CHILDRESS SD CHILTONSD CHINA SPRING ISO CHISUM ISO CHRJSTOVAL ISO CITY VIEW SD CLEAR CREEK ISO CLEBURNE SD CLEVELAND SD CLINTJSD CLYDECISD COLDSPRING-OAKHURST CISD COLLEGE STATION SD COLMESNEIL SD COLORADO ISO COLUMBIA-BRAZORIA ISO COMALISD COMANCHE SD COMFORT ISO COMMERCE ISO COMMUNITY ISO COMSTOCK ISO CONNALLY SD CONROESD COPPELLJSD COPPERAS COVE SD CORPUS CHRISTI ISO CORRJGAN-CAMDENISD CORSICANA ISO COTULLA ISO COUPLAND ISO CRANDALL SD CRAWFORD JSD
CROCKETT SD CROSBY ISO CROWLEY ISO CRYSTAL CITY ISO CYPRESS-FAIRBANKS SD DAINGERFIELD- LONE STAR ISO DALHART ISO DALLAS ISO DAMONISD DANBURY ISO DAYTONSD DELEON ISO DECATUR ISO DEER PARK ISD DEKALB ISO DELVALLE SD DENISON ISO DENTON ISO DENVER CITY ISO DESOTO ISO DEVERS ISO DEVINESD DICKINSON ISO DIMMITTISD DONNA ISO DRIPPING SPRINGS ISO DRISCOLL SD DUBLIN SD DUMASISD DUNCANVILLE ISO EAGLE MT-SAGINAW ISO EAGLE PASS JSD EANES SD EARLY ISO EAST CENTRAL ISO EAST CHAMBERS ISO EASTLAND SD ECTOR COUNTY SD EDCOUCH-ELSA SD EDGEWOOD SD EDGEWOOD SD EDINBURG CSD EL PASO ISO ELECTRA ISO ELGINISD ELKHARTJSD ENNIS ISO ETOLEISD EULAISD EVADALEISD EVERMAN ISO EZZELL ISO FABENSISD FAIRFIELD ISD FARMERSVILLE SD FERRIS ISO FLORENCE SD FLORESVILLE SD FLOUR BLUFF SD FORNEY ISO FORSAN ISO FORT BEND SD FORT STOCKTON SD FORT WORTH SD FRANKLIN ISO FRANKSTON SD FREDERICKSBURG ISO FRENSHil ISO FRIENDSWOOD ISO FRJONAISD FRISCOISD FT SAM HOUSTON ISO GAINESVILLE SD GALENA PARK SD GALVESTON SD GARLAND ISO GATESVILLE SD
GEORGE WEST SD GEORGETOWN SD GIDDINGS SD GLADEWATER ISO GLEN ROSE SD GODLEY ISO GOLDTHWAITE ISO GONZALES ISO GOOSE CREEK CISD GRAHAMJSD GRANBURY ISO GRAND PRAIRIE SD GRAND SALINE SD GRANDVIEW ISO GRANGER ISO GRAPE CREEK SD GRAPEVINE-COLLEYVILLE SD GREENVILLE ISO GREENWOOD SD GREGORY -PORTLAND SD GROESBECK ISO GROVETON SD GUSTINE ISO HALLSVILLE SD HAMILTON ISO HAMSHIRE-FANNETT ISO HARDIN ISO HARDIN-JEFFERSON ISO HARLANDALE SD HARLINGEN CISD HARROLDISD HAWKINS ISO HAWLEYISD HAYSCISD HEMPHILL SD HEMPSTEAD ISO HENDERSON ISO HENRJETTA ISO HEREFORD ISO HICOISD HIDALGO ISO HIGH ISLAND SD HIGHLAND PARK JSD HIGHLAND PARK ISO HILLSBORO ISO HITCHCOCK ISO HOLLAND ISO HOLLIDAY ISO HONDOISD HOUSTON ISO HUCKABAY ISO HUFFMAN ISO HULL-DAISETTA ISO HUMBLE ISO HUNTSVILLE SD HURST-EULESS-BEDFORD SD HUTTOISD IDALOU ISO INGLESIDE SD INGRAM ISO IOWAPARKCISD IRVINGISD ITALY SD JACKSONVILLE SD JARRELLJSD JASPER ISO JIM HOGG COUNTY SD JIM NED CSD JOSHUA ISO JOURDANTON ISO JUDSONISD KATYISD KAUFMAN ISO KEENEISD KELLER ISO KEMPJSD KENNEDALE ISO
ATTACHMENT A
KERMITISD KERRVILLE SD KJLGOREISD KILLEEN SD KINGSVILLE ISO KIRBYVILLE CJSD KLEINISD KNilPA ISO KOUNTZE ISO KRUMISD LAFERJAJSD LA GRANGE ISO LAJOYAISD LA MARQUE SD LAPORTE ISO LA VEGAISD LA VERNIA SD LA VJLLAISD LACKLAND ISO LAGO VISTA SD LAKE DALLAS JSD LAKE TRAVIS JSD LAKE WORTH SD LAMARCISD LAMESAISD LAMPASAS ISO LANCASTER ISO LAREDO ISO LASARAISD LATEXOISD LEANDERISD LEVELLAND ISO LEWISVILLE ISO LIBERTY HILL ISO LWERTYISD LWERTY-EYLAU ISO LINDALE ISO LINGLEVILLE ISO LIPANISD LITTLE CYPRESS-MAURICEVILLE CJSD LITTLE ELM ISO LITTLEFIELD ISD LIVINGSTON ISO LLANOISD LOCKHART ISD LONDON ISO LONGVIEW ISO LORENA ISO LOS FRESNOS CISD LOVEJOY ISO LOVELADY ISO LUBBOCK ISO LUBBOCK-COOPER ISO LUFKIN ISO LULING ISO LUMBERTON JSD LYFORDCISD LYTLE ISO MABANK ISO MADISONVILLE CISD MAGNOLIA ISO MANORISD MANSFIELD ISO MARBLE FALLS ISO MARlONISD MARLIN ISO MARSHALL ISO MARTISD MATAGORDA ISO MATHIS ISO MAY ISO MAYPEARL ISO MCALLEN ISO MCGREGOR ISO MCKINNEY SD MCLEOD ISO
MEDINA VALLEY SD MELISSASD MERCEDES SD MERKELISD MESQUITE ISO MEXIAISD MEYERSVILLE ISO MIDLAND ISO MIDLOTHIAN ISO MIDWAY ISO MIDWAY ISO MILES SD MILFORD ISO MINEOLAISD MINERAL WELLS ISO MISSION CISD MONAHANS-WICKETI-PYOTE SD MONTE ALTO ISO MONTGOMERY ISO MOODY ISO MORGAN MILL ISO MOUNT PLEASANT SD MOUNT VERNON ISO MULESHOE SD NACOGDOCHES ISO NATALIA ISO NAVARRO ISO NAVASOTA SD NEDERLAND ISO NEEDVILLE ISO NEW BOSTON ISO NEW BRAUNFELS SD NEW CANEY SD NEW DEAL ISO NEW WAVERLY ISO NEWTON ISO NIXON-SMILEY CISD NORTH EAST ISO NORTH FOREST ISO NORTH LAMAR ISO NORTHSIDE ISO NORTHWEST ISO ODEM -EDROY ISO OGLESBY ISO OLNEY ISO ONALASKA ISO ORANGE GROVE ISO ORANGEFIELD ISO OVERTON ISO PALACIOS ISO PALESTINE ISO PALMER ISO PAMPA ISO PARIS ISO PASADENA ISO PEARLAND SD PEARSALL ISO PEASTERISD
PECOS-BARSTOW-TOYAH ISO PERRYTON ISO PETERSBURG ISO PETROLIA CISD PEWITTCISD PFLUGERVILLE ISO PHARR-SAN JUAN-ALAMOISD PILOT POINT ISO PINE TREE ISO PITTSBURG ISO PLAINVIEW ISO PLANO ISO PLEASANT GROVE ISO PLEASANTON SD POINT ISABEL ISO PONDER ISO POOLVILLE ISO PORT ARANSAS ISO PORT ARTHUR ISO PORT NECHES-GROVES ISO POTEET ISO POTISBORO ISO PRAJRILAND ISO PRESIDIO ISO PRINCETON ISO PROGRESO ISO PROSPER ISO QUINLAN ISO RANDOLPH FIELD SD RAYMONDVILLE ISO REDOAKISD REDWATER ISO RICHARDS ISO RICHARDSON ISO RIESEL ISO RIO GRANDE CITY CISD RlO HONDO ISO RlO VISTA ISO RJVER ROAD SD RJVERCREST ISO RIVIERA ISO ROBINSON ISO ROBSTOWN ISO ROCKDALE ISO ROCKWALL SD ROGERSISD ROMA ISO ROOSEVELTISO ROPES ISO ROSCOE COLLEGIATE SD ROUND ROCK SD ROXTON ISO ROYAL ISO ROYSE CITY SD RUSKISD SABINE PASS ISO SALADOISD SAN ANGELO ISO SAN ANTONIO ISO
SAN BENITO CISD SAN DIEGO ISO SAN ELIZARIO ISD SAN FELIPE-DEL RIO CISD SAN ISIDRO ISO SAN MARCOS CJSD SANGER ISO SANTA FE ISO SANTA MARIA ISO SANTA ROSA ISO SCHERTZ-ClBOLO-U CITY ISO SCURRY -ROSSER ISO SEALY ISO SEGUINISD SEMINOLE ISO SEYMOUR ISO SHALLOWATER ISO SHARYLAND ISO SHELDON ISO SHEPHERD ISO SHERMAN ISO SIDNEY ISO SILSBEE ISO SINTON ISO SLATON ISO SMITHVILLE SD SMYER ISO SNYDER ISO SOCORRO ISO SOMERSET SD SOUTH SAN ANTONIO ISO SOJTIJ TEXAS ISD SOUTHSIDE ISO SOUTHWEST SD SPLENDORA ISO SPRING BRANCH ISO SPRJNGISD SPRINGTOWN ISO SPURGER ISO STAFFORD MSD STAMFORD ISO STANTONISD STEPHENVILLE SD SULPHUR BLUFF ISO SULPHUR SPRlNGS ISO SUNNYVALE SD SWEENY ISO SWEETWATER ISO TAFTISD TAHOKAISD TARKINGTON ISD TAYLOR ISO TEAGUE ISO TEMPLEISD TERLINGUA CSD TERRELL COUNTY ISO TERRELLISD TEXARKANA ISO TEXAS CITY ISO
ATTACHMENT A
THRALLISD THREE WAY ISO TIDEHAVEN ISO TOLARISD TOM BEAN ISO TOMBALL ISO TORNJLLO SD TRENTISD TRINITY ISO TROUP ISO TROY ISO TULOSO-MIDWAY SD TYLERISD UNITEDISD UVALDECISD VALLEY MILLS ISO VALLEY VIEW ISO VALLEY VIEW SD VAN ALSTYNE ISO VAN ISO VAN VLECK SD VENUSISD VERlBEST ISO VERNONISD VICTORIA ISO VIDORISD VYSEHRAD ISO WACO ISO WALL ISO WALLERISD WARREN ISO WATER VALLEY ISO WAXAHACHIE ISO WEATHERFORD SD WESLACOISD WESTISD WEST ORANGE-COVE CISD WESTOSOISD WEST RUSK COUNTY CONSOLIDATED ISO WEST SABINE ISO WHITE SETILEMENT ISO WHITEHOUSE SD WHITESBORO ISO WHITNEY ISO WICHIT A FALLS ISO WILDORADO SD WILLIS ISO WILLS POINT SD WILSONISD WIMBERLEY ISO WINDTHORST SD WJNONAISD WOODVILLE ISO WYLIEISD WYLIE ISO YSLETAISD ZAPATA COUNTY ISO ZEPHYRISD
Table of Contents
Explanation of Renewal Process 4
Application Instructions 5
Selected Definitions 6
Application Sections
Section I Coversheet (Attachment A) 7 This is a printout of current charter holder information from the TEA Division of Charter School Administration database the CSTS and must be attached as the application coversheet (Attachment A)
Section II Contact Information 8 Requires the charter holder to provide the current contact information for the superintendent the charter holder board chair and the person who prepared the application
Section III Website Postings 9 Requires the charter holder to provide the homepage web address where the names of the members of the governing body are listed the web address where the superintendents salary is posted and web address where the charter financial statements are continuously posted as required by Local Government Code sect140006
Section IV Organizational Charts 10 Requires the charter holder to provide the organizational chart of the charter school as well as a chart showing other entities and programs managed by the charter holder This section requires the submission of attachments 1and 2
Section V Admission Policy 11 Requires the charter holder to provide details concerning the charter schools admission policy and practices In addition this section requires the submission of attachments 3 4 and 5
Section VI Special Education Assurances 14 Requires the charter holder to certify that it has policies and procedures in place that ensure implementation ofall federal Jaws and regulations Texas laws State Board of Education rules and commissioner rules related to students with disabilities and further assures that any future amendments to the regulations Jaws and rules will be incorporated and implemented This section must be signed by the charter holder board chair
Section VII Serving Students at Residential Facilities Assurances 15 This section is required only when the charter educates students at a residential facility Requires the charter holder to certify that it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education rules and commissioner rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the Jaws regulations and rules will be incorporated and implemented If required this section must be signed by the charter holder board chair
Section VIII BilingualESL Section 504 and Dyslexia Assurances 17 Requires the charter holder to certify that it has policies and procedures in place ensuring that it complies with the legal and regulatory requirements concerning identifying and providing appropriate education services to limited English proficient students students protected by Section 504 of the Rehabilitation Act of 1973 and students with dyslexia or related disorders This section must be completed and signed by the charter holder board chair
Page 2
Section IX Fingerprinting and Criminal Record Check Assurance 18 Requires the charter holder to certify that it is in compliance with TEC sect 12120 and confirms that no individual is serving in any capacity ifhe or she has been convicted ofa misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code of Criminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Section X Certificate of Acknowledgement 19 Requires at least a majority of the governing body of the charter holder to certify that it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of the renewal of the charter
Texas Education Agency Contact Information 20
Renewal Process Flowchart 21
Attachments Required of Applicant
Charter School Organizational Chart (Attachment I)
Charter Holder Organizational Chart (Attachment 2)
Admission Policy (Attachment 3)
Admission Application (Attachment 4)
Enrollment Form (Attachment 5)
Pagc3
Explanation of Renewal Process
19 Texas Administrative Code (TAC) sectI 00 103J contains additional information about charter renewal
The renewal process is separate from the charter amendment process Significant changes from the original charter should not be made in the renewal application unless a charter amendment has been previously approved
As authorized in Texas Education Code (TEC) sect121141 the commissioners procedures for renewal must include three distinct processes expedited renewal discretionary renewal and expiration
Definitions of the three renewal processes
Expedited (30 days) If in the preceding 3 years bull Highest or second highest academic performance rating bull Satisfactory or higher financial rating and bull No campus has been assigned the lowest rating or no campus has been closed for low ratings
Discretionary (90 days) Consideration among others of bullAcademic Performance 2009-2010 2010-2011 2012-2013 2013-2014 bull Financial Ratings 2009-2010 20I0-2011 2011-2012 2012-2013 2013-2014 bullPerformance Framework (TEC sect121181)
Expiration (30 day notification) If for any 3 of the 5 preceding school years bull Lowest academic performance rating bull Lower than satisfactory financial rating bull The charter was assigned any combination of ratings or bull A campus has been assigned the lowest performance rating for the 3 preceding school years and has not been closed
The due date for charters to submit the completed renewal application to the Texas Education Agency (TEA) is Wednesday January 7 2015
You may request an informal review of the findings and actions described in this letter by sending a written request to
Brandon Spenrath Program Specialist Charter School Administration Texas Education Agency 170 I North Congress Ave Austin Texas 7870 I Fax (512) 936-9281 brand on spen rat h(iitea state tx us
The request must be received no later than Wednesday December 17 2014 Your request must identify what changes you are requesting the reasons for your request and documentation to support your request If we do not receive your request before the deadline final action will be taken without further review
Please see 19 TAC Chapter 157 subchapter EE Division I for addition information about the informal review process
Pagc4
Application Instructions
The renewal application contains ten sections to be completed electronically printed into hardcopy form for required signatures and dates and submitted on or before the due date to the Division ofCharter School Administration
1 Deadline The completed application must be returned by mail to the Division ofCharter School Administration by Wednesday January 7 2015
2 Typing Requirement All of the responses to the application sections with the exception ofsignatures and dates of signatures must be typed
3 Printing Requirement The application must be printed on one-sided 8 I 2 x 11 white paper
4 Signature Requirement Where signatures and dates ofsignatures are required they must be in blue ink
5 Submission of Original Document and One Copy The completed and unbound (rubber bands or clips are acceptable) original renewal application including fillable forms and attachments and one additional copy must be submitted as follows
Texas Education Agency Division ofCharter School Administration
170 I North Congress A venue Austin Texas 7870 I
Page 5
Selected Definitions
Please review TEC sect12 I OJ 2 and 19 TAC sect1001001 for definitions of terms which are available at the education laws and mies page Listed below are selected terms and definitions
bull Charter holder - the entity to which a charter is granted under TEC Chapter 12
bull Charter school - a Texas public school operated by a charter holder under an open-enrollment charter granted by the commissioner n pursuant to TEC sect12 J01
Governing body ofa charter holder - the board of directors board of tmstees or other governing body of a charter holder
bull Governing body ofa charter school - the board of directors board of trustees or other governing body of an open-enrollment charter school the term includes the governing body ofa charter holder ifthat body acts as the governing body of the open-enrollment charter school
bull Management company - a person or entity other than a charter holder that provides management services for an open-enrollment charter school
bull Officer ofa charter school - the principal director or other chief operating officer of an open-enrollment charter school an assistant principal or assistant director of an open-enrollment charter school or a person charged with managing the finances ofan open-enrollment charter school
bull Board chair or chaitperson - generally the board president or presiding officer of the governing board
Page 6
Section I
Coversheet
ATTACHMENT A OPEN-ENROLLMENT CHARTER CONTRACT RENEWAL
The enclosed document entitled OPEN-ENROLLMENT CHARTER CONTRACT RENEW AL will serve as the coversheet when the application is completed and submitted and includes current information in the Charter School Tracking System Verify the accuracy of the information on the coversheet and if updates to the information are needed create a separate sheet detailing your corrections and label the sheet Update to Data Provided by TEA and include it in the renewal packet immediately following the preprinted coversheet
Pagc7
Section II
Contact Information
The persons listed below will be contacted by agency staff ifthere are issues to be resolved in any ofthe renewal application sections Note that any contact information including email addresses provided with the renewal application will be public information
Superintendent Contact Information
Superintendents Name lcharles Cook
=============================================== Telephone Number 1(972) 316-3663
=============================================== Fax Number 1972-315-9506
=========================================~ E-mail Address lccookresponsiveedcom
Charter Holder Board Chair Contact Information
Board Chairs Name Marvin Reynolds
Telephone Number 1866-605-7772
Fax Number 1972-315-9506
E-mail Address leducatenationalhomeschoolcom
Application Preparers Contact Information El Same as Superintendent D Same as Board Chair
Contact Name lcharles Cook
Telephone Number 1(972) 316-3663
Fax Number 1972-315-9506
E-mail Address lccookresponsiveedcom
Charter School Website
Web address lhttppremierhighschoolscom
Page 8
Section III
Website Postings
In accordance with the requirements of TEC sect12 1211 an open-enrollment charter school shall list the names of the members of the governing body on the home page of the schools internet website Provide the internet URL address where the names of the members of the governing body are listed
httppremierhighschoolscomtexas-state-requi red-information
In accordance with the requirements of TEC sect12 136 an open-enrollment charter school shall post the salary of the schools superintendent or CEO on the schools internet website Provide the internet URL address where the superintendents salary is posted
httppremierhighschoolscomtexas-state-required-information
In accordance with Local Government Code sect140006 an open-enrollment charter school shall post continuously on the schools internet website the annual financials of the school Provide the internet URL address where the annual financial statements of the charter school are continuously posted
httppremierhighschoolscomtexas-state-required-information
Page9
Section IV
Organizational Charts
Submit as Attachment 1 the organizational chart for the charter school that specifies the administrative positions including the title and name of the individual currently in each position
Submit as Attachment 2 a chart that identifies all other entities under the direction of the charter holder This would include entities andor programs that the charter holder governsmanages in addition to the charter school
Page 10
I I
I I
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middot~middot==middot==middotmiddotmiddotmiddot~~ Robert Davison liChief Operating O~cj
~1~ middotmiddotmiddotmiddotmiddotmiddot shyOr Mary Ann Duncan Gary Arnold Corey Thomas
VP-School VP - Human InformationI Operations I Resources Technology (IT)
--~~1~-- ---~~~
middotmiddotmiddotmiddotmiddotmiddot-middot -middot~ ----- shy
Kim OLeary PEIMS
ResponsiveEdPremier High Schools
Board of Directors
Chuck Cook Superintendent I
Chief Executive Officer
I Chris eaumaOn bull
General Counsel IVP - Business Oevelooment I
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Jeffrie Evans Terri Baumann Brian Stevens carrie Alexander
Marketing amp Curriculum Facilities VP - Finance
Communications Development
I I
Regional Directors of Regional Directors of Operations Academics
campus Directors shyPremier High School shy
Premier High School Campus Staff
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Or Alan Wimberley Chief Education
Architect
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Wesley Cockrum I=Software Kyle Queal
Development - Academics -----I_____
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Responsive Education bullt--------------------------iI R~~~i~~=~~~~=~1Solutions
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1rmiddot~middot=middotmiddotmiddot=middot~-~--~middot-I Texas Education
Texas Education Indianapolis MayorsAustin Independent llAgency- Texas College Ohio Council ofd~~Amiddotdcp_p1 [~~
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Agency- Premier High Office of EducationSchool District - 2 Preparatory Community Schools I State Board of Schools Charter Innovation - 1 School
Sites Academies Charter -5 Schoolsf roved I II Education -4 Charters District - 32 Sites ApprovedI District - 33 Sites Approved
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Section V
Admission Policy
Pie e be aware that any change to the terms ofan open-enrollment charter that relates to the following subjects
ade levels bullma middotmum enrollment
hie boundaries bullapprove ampus(es) bull approved s s bull relocation of bull charter holder n e bullcharter school (dis ct) name bull charter campus name bullcharter holder goveman bull articles of incorporation bull corporate bylaws bullmanagement company bull admission policy or bull the educational program of the sch
requires the commissioner ofeducations approva fan amendment (See sectI00 1033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admis middot n are accepted TEC sectI2117 requires that a charter school establish a reasonable application deadline for the 1bmission ofapplications for admission
Beginning of Period (MonthDay)
May4 2015
B If the school admits students by lottery when the number of admissions ap middotcations received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Not applicable
C If the school utilizes a lottery when oversubscribed are any categories ofapplicants exempted from th lottery
0Ycs
0No
0 Not applicable (because lotteries arc not utilized)
If Yes was indicated in C above state the categories ofapplicants that are exempted
Page 11
Section V
Admission Policy
Please be aware that any change to the terms of an open-enrollment charter that relates to the following subjects
bull grade levels bullmaximum enrollment bull geographic boundaries bullapproved campus(es) bull approved sites bull relocation of campus bull charter holdername bull charter school (district) name bull charter campus name bull charter holder governance bull articles of incorporation bullcorporate bylaws bull management company bull admission policy or bullthe educational program of the school
requires the commissioner of educations approval ofan amendment (See sect1001033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadline for the submission ofapplicationsfor admission
Beginning ofPeriod (MonthDay) End of Period (MonthDay)
--~~~-M-ay_4__2_01_s~~~--I l__~~~M_a_y_1_a_2_0_1s~~~---
B If the school admits students by lottery when the number of admissions applications received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Aname (or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) Is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order in which they were drawn Notification of admission will be made and failure of a parent to respond within 48 hours of notification will forfeit his or her position in the lottery
C lfthe school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
0Yes
ONo
0 Not applicable (because lotteries are not utilized)
IfYes was indicated in C above state the categories of annlicants that are exempted
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Page 11
Section V (Continued)
Admission Policy
e school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be con led
Approximate Date of Lottery (MonthDay) ceuroSS ~ ~l-0
NA coll11lGeurolc
0ull-1lG E If the school does not utilize ottery when oversubscribed bu lleuroJSeuro~euroll-l ctole positions in the order in which
applications were received befo the expiration of the applicatil seuroeuro l 11e a first-come first-served admission process) describe the manner in ich the school notifies the ct bull 11unity of the opportunity to apply for admission TEC sect12 117 requires a charter sc of that uses ajirst-comefirst-served admission process when ove1mbscribed to publish a notice in a newspaper ofge1 ral circulation not later than the seventh day before the application deadline
Advertisements are published in the local newspap notifying the community of the Open-Enrollment Period for the school at least seven days before the close of the Ope Enrollment Period
F lfthe school has a separate process for re-enrollment state e process and the timeline to be used
he Re-Enrollment Period will begin May 4 2015 and end May 14 2 15 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 15 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the ignated window as listed above Students who could continue at their current campus but wish to transfer to a different mier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and o in a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application dea ine has passed
If an Application is received from an eligible applicant after the close of the open-enrollment p iod the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely ap ied
H Describe the infom1ation that an applicant must provide in order to be considered for admission Appi ants may not be required to provide copies of transcripts or other academic records until after they are offered od1 middotsion and are enrolling Furthermore a student may not be precluded ji-om enrolling due to the charter schools fail e to receive biformation required for enrollment ji-om the students parent or guardian or previous school See TEC sect2 002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date ofLottery (MonthDay)
0520 APPROVED DURING CONTINGENCY PROCESS
E If the school does not utilize a lottery when oversubscribed but rather fills the available positions in the order in which applications were received before the expiration ofthe application deadline (ie a first-come first-served admission process) describe the manner in which the school notifies the community of the opportunity to apply for admission TEC sect12117 requires a charter school that uses a first-come first-served admission process when oversubscribed to publish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
NIA
F If the school has a separate process for re-enrollment state the process and the timeline to be used
lfhe Re-Enrollment Period will begin May 4 2015 and end May 14 2015 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 2015 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the designated window as listed above Students who could continue at their current campus but wish to transfer to a different Premier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and obtain a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application deadline has passed
If an Application Is received from an eligible applicant after the close of the open-enrollment period the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
H Describe the information that an applicant must provide in order to be considered for admission Applicants may not be required to provide copies of transcripts or other academic records until after they are offered admission and are enrolling Furthermore a student may not be precluded from enrolling due to the charter schools failure to receive information required for enrollment from the students parent or guardian or previous school See TEC sect25002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
I The charter holder certifies that the non-discrimination statement required by TEC sectI2 I I I (a)(5) is printed in the schools admission policy TEC sect121 I I (a)(5) requires that a charter schools admission policy include a statement that the school will not discriminate in admissions based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend
0Ycs
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories ofa criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 3 7 Subchapter A as authorized by TEC sectI21 II (a)(5)(B)
0 Yes (The school excludes such students or reserves the right to exclude such students from admissions)
0 No (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bullA current copy of the admission policy that incorporates the information provided in the above answers to questions
A through H and any other relevant information (Attachment 3)
bull A blank copy of the current admission application ie the information requested when the student first seeks
admission (Attachment 4) and
bullA blank copy of the current enrollment form(s) ie the information required once an applicant has been offered
admission and is registering for enrollment (Attachment 5)
Page 13
I I
i
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
BRENHAM ISO BRIDGE CITY ISO BRIDGEPORT ISO BROCKISD BROOKELAND ISO BROOKESMITH ISO BROOKS COUNTY ISO BROWNFIELD ISO BROWNSBORO ISO BROWNSVILLE ISO BROWNWOOD ISO BRUCEVILLE-EDDY JSD BRYAN ISO BULLARD ISO BUNAISD BURKBURNETT ISO BURKEVILLE ISO BURLESON SD BURNETCISD BURTON ISO BUSHLAND ISO CADDO MILLS ISO CALALLEN JSD CALDWELL ISO CALHOUN COUNTY ISO CAMERON ISO CANTON ISO CANUTJLLO ISO CANYON ISO CARLISLE ISO CARRIZO SPRINGS CISD CARROLL ISO CARROLLTON-FARMERS BRANCH ISO CARTHAGE SD CASTLEBERRY JSD CEDAR HILL SD CELINA ISO CENTERVILLE SD CENTERVILLE ISO CHANNELVIEW JSD CHANNING ISO CHAPEL HILL ISO CHAPEL HILL SD CHILDRESS SD CHILTONSD CHINA SPRING ISO CHISUM ISO CHRJSTOVAL ISO CITY VIEW SD CLEAR CREEK ISO CLEBURNE SD CLEVELAND SD CLINTJSD CLYDECISD COLDSPRING-OAKHURST CISD COLLEGE STATION SD COLMESNEIL SD COLORADO ISO COLUMBIA-BRAZORIA ISO COMALISD COMANCHE SD COMFORT ISO COMMERCE ISO COMMUNITY ISO COMSTOCK ISO CONNALLY SD CONROESD COPPELLJSD COPPERAS COVE SD CORPUS CHRISTI ISO CORRJGAN-CAMDENISD CORSICANA ISO COTULLA ISO COUPLAND ISO CRANDALL SD CRAWFORD JSD
CROCKETT SD CROSBY ISO CROWLEY ISO CRYSTAL CITY ISO CYPRESS-FAIRBANKS SD DAINGERFIELD- LONE STAR ISO DALHART ISO DALLAS ISO DAMONISD DANBURY ISO DAYTONSD DELEON ISO DECATUR ISO DEER PARK ISD DEKALB ISO DELVALLE SD DENISON ISO DENTON ISO DENVER CITY ISO DESOTO ISO DEVERS ISO DEVINESD DICKINSON ISO DIMMITTISD DONNA ISO DRIPPING SPRINGS ISO DRISCOLL SD DUBLIN SD DUMASISD DUNCANVILLE ISO EAGLE MT-SAGINAW ISO EAGLE PASS JSD EANES SD EARLY ISO EAST CENTRAL ISO EAST CHAMBERS ISO EASTLAND SD ECTOR COUNTY SD EDCOUCH-ELSA SD EDGEWOOD SD EDGEWOOD SD EDINBURG CSD EL PASO ISO ELECTRA ISO ELGINISD ELKHARTJSD ENNIS ISO ETOLEISD EULAISD EVADALEISD EVERMAN ISO EZZELL ISO FABENSISD FAIRFIELD ISD FARMERSVILLE SD FERRIS ISO FLORENCE SD FLORESVILLE SD FLOUR BLUFF SD FORNEY ISO FORSAN ISO FORT BEND SD FORT STOCKTON SD FORT WORTH SD FRANKLIN ISO FRANKSTON SD FREDERICKSBURG ISO FRENSHil ISO FRIENDSWOOD ISO FRJONAISD FRISCOISD FT SAM HOUSTON ISO GAINESVILLE SD GALENA PARK SD GALVESTON SD GARLAND ISO GATESVILLE SD
GEORGE WEST SD GEORGETOWN SD GIDDINGS SD GLADEWATER ISO GLEN ROSE SD GODLEY ISO GOLDTHWAITE ISO GONZALES ISO GOOSE CREEK CISD GRAHAMJSD GRANBURY ISO GRAND PRAIRIE SD GRAND SALINE SD GRANDVIEW ISO GRANGER ISO GRAPE CREEK SD GRAPEVINE-COLLEYVILLE SD GREENVILLE ISO GREENWOOD SD GREGORY -PORTLAND SD GROESBECK ISO GROVETON SD GUSTINE ISO HALLSVILLE SD HAMILTON ISO HAMSHIRE-FANNETT ISO HARDIN ISO HARDIN-JEFFERSON ISO HARLANDALE SD HARLINGEN CISD HARROLDISD HAWKINS ISO HAWLEYISD HAYSCISD HEMPHILL SD HEMPSTEAD ISO HENDERSON ISO HENRJETTA ISO HEREFORD ISO HICOISD HIDALGO ISO HIGH ISLAND SD HIGHLAND PARK JSD HIGHLAND PARK ISO HILLSBORO ISO HITCHCOCK ISO HOLLAND ISO HOLLIDAY ISO HONDOISD HOUSTON ISO HUCKABAY ISO HUFFMAN ISO HULL-DAISETTA ISO HUMBLE ISO HUNTSVILLE SD HURST-EULESS-BEDFORD SD HUTTOISD IDALOU ISO INGLESIDE SD INGRAM ISO IOWAPARKCISD IRVINGISD ITALY SD JACKSONVILLE SD JARRELLJSD JASPER ISO JIM HOGG COUNTY SD JIM NED CSD JOSHUA ISO JOURDANTON ISO JUDSONISD KATYISD KAUFMAN ISO KEENEISD KELLER ISO KEMPJSD KENNEDALE ISO
ATTACHMENT A
KERMITISD KERRVILLE SD KJLGOREISD KILLEEN SD KINGSVILLE ISO KIRBYVILLE CJSD KLEINISD KNilPA ISO KOUNTZE ISO KRUMISD LAFERJAJSD LA GRANGE ISO LAJOYAISD LA MARQUE SD LAPORTE ISO LA VEGAISD LA VERNIA SD LA VJLLAISD LACKLAND ISO LAGO VISTA SD LAKE DALLAS JSD LAKE TRAVIS JSD LAKE WORTH SD LAMARCISD LAMESAISD LAMPASAS ISO LANCASTER ISO LAREDO ISO LASARAISD LATEXOISD LEANDERISD LEVELLAND ISO LEWISVILLE ISO LIBERTY HILL ISO LWERTYISD LWERTY-EYLAU ISO LINDALE ISO LINGLEVILLE ISO LIPANISD LITTLE CYPRESS-MAURICEVILLE CJSD LITTLE ELM ISO LITTLEFIELD ISD LIVINGSTON ISO LLANOISD LOCKHART ISD LONDON ISO LONGVIEW ISO LORENA ISO LOS FRESNOS CISD LOVEJOY ISO LOVELADY ISO LUBBOCK ISO LUBBOCK-COOPER ISO LUFKIN ISO LULING ISO LUMBERTON JSD LYFORDCISD LYTLE ISO MABANK ISO MADISONVILLE CISD MAGNOLIA ISO MANORISD MANSFIELD ISO MARBLE FALLS ISO MARlONISD MARLIN ISO MARSHALL ISO MARTISD MATAGORDA ISO MATHIS ISO MAY ISO MAYPEARL ISO MCALLEN ISO MCGREGOR ISO MCKINNEY SD MCLEOD ISO
MEDINA VALLEY SD MELISSASD MERCEDES SD MERKELISD MESQUITE ISO MEXIAISD MEYERSVILLE ISO MIDLAND ISO MIDLOTHIAN ISO MIDWAY ISO MIDWAY ISO MILES SD MILFORD ISO MINEOLAISD MINERAL WELLS ISO MISSION CISD MONAHANS-WICKETI-PYOTE SD MONTE ALTO ISO MONTGOMERY ISO MOODY ISO MORGAN MILL ISO MOUNT PLEASANT SD MOUNT VERNON ISO MULESHOE SD NACOGDOCHES ISO NATALIA ISO NAVARRO ISO NAVASOTA SD NEDERLAND ISO NEEDVILLE ISO NEW BOSTON ISO NEW BRAUNFELS SD NEW CANEY SD NEW DEAL ISO NEW WAVERLY ISO NEWTON ISO NIXON-SMILEY CISD NORTH EAST ISO NORTH FOREST ISO NORTH LAMAR ISO NORTHSIDE ISO NORTHWEST ISO ODEM -EDROY ISO OGLESBY ISO OLNEY ISO ONALASKA ISO ORANGE GROVE ISO ORANGEFIELD ISO OVERTON ISO PALACIOS ISO PALESTINE ISO PALMER ISO PAMPA ISO PARIS ISO PASADENA ISO PEARLAND SD PEARSALL ISO PEASTERISD
PECOS-BARSTOW-TOYAH ISO PERRYTON ISO PETERSBURG ISO PETROLIA CISD PEWITTCISD PFLUGERVILLE ISO PHARR-SAN JUAN-ALAMOISD PILOT POINT ISO PINE TREE ISO PITTSBURG ISO PLAINVIEW ISO PLANO ISO PLEASANT GROVE ISO PLEASANTON SD POINT ISABEL ISO PONDER ISO POOLVILLE ISO PORT ARANSAS ISO PORT ARTHUR ISO PORT NECHES-GROVES ISO POTEET ISO POTISBORO ISO PRAJRILAND ISO PRESIDIO ISO PRINCETON ISO PROGRESO ISO PROSPER ISO QUINLAN ISO RANDOLPH FIELD SD RAYMONDVILLE ISO REDOAKISD REDWATER ISO RICHARDS ISO RICHARDSON ISO RIESEL ISO RIO GRANDE CITY CISD RlO HONDO ISO RlO VISTA ISO RJVER ROAD SD RJVERCREST ISO RIVIERA ISO ROBINSON ISO ROBSTOWN ISO ROCKDALE ISO ROCKWALL SD ROGERSISD ROMA ISO ROOSEVELTISO ROPES ISO ROSCOE COLLEGIATE SD ROUND ROCK SD ROXTON ISO ROYAL ISO ROYSE CITY SD RUSKISD SABINE PASS ISO SALADOISD SAN ANGELO ISO SAN ANTONIO ISO
SAN BENITO CISD SAN DIEGO ISO SAN ELIZARIO ISD SAN FELIPE-DEL RIO CISD SAN ISIDRO ISO SAN MARCOS CJSD SANGER ISO SANTA FE ISO SANTA MARIA ISO SANTA ROSA ISO SCHERTZ-ClBOLO-U CITY ISO SCURRY -ROSSER ISO SEALY ISO SEGUINISD SEMINOLE ISO SEYMOUR ISO SHALLOWATER ISO SHARYLAND ISO SHELDON ISO SHEPHERD ISO SHERMAN ISO SIDNEY ISO SILSBEE ISO SINTON ISO SLATON ISO SMITHVILLE SD SMYER ISO SNYDER ISO SOCORRO ISO SOMERSET SD SOUTH SAN ANTONIO ISO SOJTIJ TEXAS ISD SOUTHSIDE ISO SOUTHWEST SD SPLENDORA ISO SPRING BRANCH ISO SPRJNGISD SPRINGTOWN ISO SPURGER ISO STAFFORD MSD STAMFORD ISO STANTONISD STEPHENVILLE SD SULPHUR BLUFF ISO SULPHUR SPRlNGS ISO SUNNYVALE SD SWEENY ISO SWEETWATER ISO TAFTISD TAHOKAISD TARKINGTON ISD TAYLOR ISO TEAGUE ISO TEMPLEISD TERLINGUA CSD TERRELL COUNTY ISO TERRELLISD TEXARKANA ISO TEXAS CITY ISO
ATTACHMENT A
THRALLISD THREE WAY ISO TIDEHAVEN ISO TOLARISD TOM BEAN ISO TOMBALL ISO TORNJLLO SD TRENTISD TRINITY ISO TROUP ISO TROY ISO TULOSO-MIDWAY SD TYLERISD UNITEDISD UVALDECISD VALLEY MILLS ISO VALLEY VIEW ISO VALLEY VIEW SD VAN ALSTYNE ISO VAN ISO VAN VLECK SD VENUSISD VERlBEST ISO VERNONISD VICTORIA ISO VIDORISD VYSEHRAD ISO WACO ISO WALL ISO WALLERISD WARREN ISO WATER VALLEY ISO WAXAHACHIE ISO WEATHERFORD SD WESLACOISD WESTISD WEST ORANGE-COVE CISD WESTOSOISD WEST RUSK COUNTY CONSOLIDATED ISO WEST SABINE ISO WHITE SETILEMENT ISO WHITEHOUSE SD WHITESBORO ISO WHITNEY ISO WICHIT A FALLS ISO WILDORADO SD WILLIS ISO WILLS POINT SD WILSONISD WIMBERLEY ISO WINDTHORST SD WJNONAISD WOODVILLE ISO WYLIEISD WYLIE ISO YSLETAISD ZAPATA COUNTY ISO ZEPHYRISD
Table of Contents
Explanation of Renewal Process 4
Application Instructions 5
Selected Definitions 6
Application Sections
Section I Coversheet (Attachment A) 7 This is a printout of current charter holder information from the TEA Division of Charter School Administration database the CSTS and must be attached as the application coversheet (Attachment A)
Section II Contact Information 8 Requires the charter holder to provide the current contact information for the superintendent the charter holder board chair and the person who prepared the application
Section III Website Postings 9 Requires the charter holder to provide the homepage web address where the names of the members of the governing body are listed the web address where the superintendents salary is posted and web address where the charter financial statements are continuously posted as required by Local Government Code sect140006
Section IV Organizational Charts 10 Requires the charter holder to provide the organizational chart of the charter school as well as a chart showing other entities and programs managed by the charter holder This section requires the submission of attachments 1and 2
Section V Admission Policy 11 Requires the charter holder to provide details concerning the charter schools admission policy and practices In addition this section requires the submission of attachments 3 4 and 5
Section VI Special Education Assurances 14 Requires the charter holder to certify that it has policies and procedures in place that ensure implementation ofall federal Jaws and regulations Texas laws State Board of Education rules and commissioner rules related to students with disabilities and further assures that any future amendments to the regulations Jaws and rules will be incorporated and implemented This section must be signed by the charter holder board chair
Section VII Serving Students at Residential Facilities Assurances 15 This section is required only when the charter educates students at a residential facility Requires the charter holder to certify that it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education rules and commissioner rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the Jaws regulations and rules will be incorporated and implemented If required this section must be signed by the charter holder board chair
Section VIII BilingualESL Section 504 and Dyslexia Assurances 17 Requires the charter holder to certify that it has policies and procedures in place ensuring that it complies with the legal and regulatory requirements concerning identifying and providing appropriate education services to limited English proficient students students protected by Section 504 of the Rehabilitation Act of 1973 and students with dyslexia or related disorders This section must be completed and signed by the charter holder board chair
Page 2
Section IX Fingerprinting and Criminal Record Check Assurance 18 Requires the charter holder to certify that it is in compliance with TEC sect 12120 and confirms that no individual is serving in any capacity ifhe or she has been convicted ofa misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code of Criminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Section X Certificate of Acknowledgement 19 Requires at least a majority of the governing body of the charter holder to certify that it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of the renewal of the charter
Texas Education Agency Contact Information 20
Renewal Process Flowchart 21
Attachments Required of Applicant
Charter School Organizational Chart (Attachment I)
Charter Holder Organizational Chart (Attachment 2)
Admission Policy (Attachment 3)
Admission Application (Attachment 4)
Enrollment Form (Attachment 5)
Pagc3
Explanation of Renewal Process
19 Texas Administrative Code (TAC) sectI 00 103J contains additional information about charter renewal
The renewal process is separate from the charter amendment process Significant changes from the original charter should not be made in the renewal application unless a charter amendment has been previously approved
As authorized in Texas Education Code (TEC) sect121141 the commissioners procedures for renewal must include three distinct processes expedited renewal discretionary renewal and expiration
Definitions of the three renewal processes
Expedited (30 days) If in the preceding 3 years bull Highest or second highest academic performance rating bull Satisfactory or higher financial rating and bull No campus has been assigned the lowest rating or no campus has been closed for low ratings
Discretionary (90 days) Consideration among others of bullAcademic Performance 2009-2010 2010-2011 2012-2013 2013-2014 bull Financial Ratings 2009-2010 20I0-2011 2011-2012 2012-2013 2013-2014 bullPerformance Framework (TEC sect121181)
Expiration (30 day notification) If for any 3 of the 5 preceding school years bull Lowest academic performance rating bull Lower than satisfactory financial rating bull The charter was assigned any combination of ratings or bull A campus has been assigned the lowest performance rating for the 3 preceding school years and has not been closed
The due date for charters to submit the completed renewal application to the Texas Education Agency (TEA) is Wednesday January 7 2015
You may request an informal review of the findings and actions described in this letter by sending a written request to
Brandon Spenrath Program Specialist Charter School Administration Texas Education Agency 170 I North Congress Ave Austin Texas 7870 I Fax (512) 936-9281 brand on spen rat h(iitea state tx us
The request must be received no later than Wednesday December 17 2014 Your request must identify what changes you are requesting the reasons for your request and documentation to support your request If we do not receive your request before the deadline final action will be taken without further review
Please see 19 TAC Chapter 157 subchapter EE Division I for addition information about the informal review process
Pagc4
Application Instructions
The renewal application contains ten sections to be completed electronically printed into hardcopy form for required signatures and dates and submitted on or before the due date to the Division ofCharter School Administration
1 Deadline The completed application must be returned by mail to the Division ofCharter School Administration by Wednesday January 7 2015
2 Typing Requirement All of the responses to the application sections with the exception ofsignatures and dates of signatures must be typed
3 Printing Requirement The application must be printed on one-sided 8 I 2 x 11 white paper
4 Signature Requirement Where signatures and dates ofsignatures are required they must be in blue ink
5 Submission of Original Document and One Copy The completed and unbound (rubber bands or clips are acceptable) original renewal application including fillable forms and attachments and one additional copy must be submitted as follows
Texas Education Agency Division ofCharter School Administration
170 I North Congress A venue Austin Texas 7870 I
Page 5
Selected Definitions
Please review TEC sect12 I OJ 2 and 19 TAC sect1001001 for definitions of terms which are available at the education laws and mies page Listed below are selected terms and definitions
bull Charter holder - the entity to which a charter is granted under TEC Chapter 12
bull Charter school - a Texas public school operated by a charter holder under an open-enrollment charter granted by the commissioner n pursuant to TEC sect12 J01
Governing body ofa charter holder - the board of directors board of tmstees or other governing body of a charter holder
bull Governing body ofa charter school - the board of directors board of trustees or other governing body of an open-enrollment charter school the term includes the governing body ofa charter holder ifthat body acts as the governing body of the open-enrollment charter school
bull Management company - a person or entity other than a charter holder that provides management services for an open-enrollment charter school
bull Officer ofa charter school - the principal director or other chief operating officer of an open-enrollment charter school an assistant principal or assistant director of an open-enrollment charter school or a person charged with managing the finances ofan open-enrollment charter school
bull Board chair or chaitperson - generally the board president or presiding officer of the governing board
Page 6
Section I
Coversheet
ATTACHMENT A OPEN-ENROLLMENT CHARTER CONTRACT RENEWAL
The enclosed document entitled OPEN-ENROLLMENT CHARTER CONTRACT RENEW AL will serve as the coversheet when the application is completed and submitted and includes current information in the Charter School Tracking System Verify the accuracy of the information on the coversheet and if updates to the information are needed create a separate sheet detailing your corrections and label the sheet Update to Data Provided by TEA and include it in the renewal packet immediately following the preprinted coversheet
Pagc7
Section II
Contact Information
The persons listed below will be contacted by agency staff ifthere are issues to be resolved in any ofthe renewal application sections Note that any contact information including email addresses provided with the renewal application will be public information
Superintendent Contact Information
Superintendents Name lcharles Cook
=============================================== Telephone Number 1(972) 316-3663
=============================================== Fax Number 1972-315-9506
=========================================~ E-mail Address lccookresponsiveedcom
Charter Holder Board Chair Contact Information
Board Chairs Name Marvin Reynolds
Telephone Number 1866-605-7772
Fax Number 1972-315-9506
E-mail Address leducatenationalhomeschoolcom
Application Preparers Contact Information El Same as Superintendent D Same as Board Chair
Contact Name lcharles Cook
Telephone Number 1(972) 316-3663
Fax Number 1972-315-9506
E-mail Address lccookresponsiveedcom
Charter School Website
Web address lhttppremierhighschoolscom
Page 8
Section III
Website Postings
In accordance with the requirements of TEC sect12 1211 an open-enrollment charter school shall list the names of the members of the governing body on the home page of the schools internet website Provide the internet URL address where the names of the members of the governing body are listed
httppremierhighschoolscomtexas-state-requi red-information
In accordance with the requirements of TEC sect12 136 an open-enrollment charter school shall post the salary of the schools superintendent or CEO on the schools internet website Provide the internet URL address where the superintendents salary is posted
httppremierhighschoolscomtexas-state-required-information
In accordance with Local Government Code sect140006 an open-enrollment charter school shall post continuously on the schools internet website the annual financials of the school Provide the internet URL address where the annual financial statements of the charter school are continuously posted
httppremierhighschoolscomtexas-state-required-information
Page9
Section IV
Organizational Charts
Submit as Attachment 1 the organizational chart for the charter school that specifies the administrative positions including the title and name of the individual currently in each position
Submit as Attachment 2 a chart that identifies all other entities under the direction of the charter holder This would include entities andor programs that the charter holder governsmanages in addition to the charter school
Page 10
I I
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middot~middot==middot==middotmiddotmiddotmiddot~~ Robert Davison liChief Operating O~cj
~1~ middotmiddotmiddotmiddotmiddotmiddot shyOr Mary Ann Duncan Gary Arnold Corey Thomas
VP-School VP - Human InformationI Operations I Resources Technology (IT)
--~~1~-- ---~~~
middotmiddotmiddotmiddotmiddotmiddot-middot -middot~ ----- shy
Kim OLeary PEIMS
ResponsiveEdPremier High Schools
Board of Directors
Chuck Cook Superintendent I
Chief Executive Officer
I Chris eaumaOn bull
General Counsel IVP - Business Oevelooment I
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Jeffrie Evans Terri Baumann Brian Stevens carrie Alexander
Marketing amp Curriculum Facilities VP - Finance
Communications Development
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Regional Directors of Regional Directors of Operations Academics
campus Directors shyPremier High School shy
Premier High School Campus Staff
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Or Alan Wimberley Chief Education
Architect
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Wesley Cockrum I=Software Kyle Queal
Development - Academics -----I_____
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Texas Education Indianapolis MayorsAustin Independent llAgency- Texas College Ohio Council ofd~~Amiddotdcp_p1 [~~
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Agency- Premier High Office of EducationSchool District - 2 Preparatory Community Schools I State Board of Schools Charter Innovation - 1 School
Sites Academies Charter -5 Schoolsf roved I II Education -4 Charters District - 32 Sites ApprovedI District - 33 Sites Approved
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Section V
Admission Policy
Pie e be aware that any change to the terms ofan open-enrollment charter that relates to the following subjects
ade levels bullma middotmum enrollment
hie boundaries bullapprove ampus(es) bull approved s s bull relocation of bull charter holder n e bullcharter school (dis ct) name bull charter campus name bullcharter holder goveman bull articles of incorporation bull corporate bylaws bullmanagement company bull admission policy or bull the educational program of the sch
requires the commissioner ofeducations approva fan amendment (See sectI00 1033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admis middot n are accepted TEC sectI2117 requires that a charter school establish a reasonable application deadline for the 1bmission ofapplications for admission
Beginning of Period (MonthDay)
May4 2015
B If the school admits students by lottery when the number of admissions ap middotcations received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Not applicable
C If the school utilizes a lottery when oversubscribed are any categories ofapplicants exempted from th lottery
0Ycs
0No
0 Not applicable (because lotteries arc not utilized)
If Yes was indicated in C above state the categories ofapplicants that are exempted
Page 11
Section V
Admission Policy
Please be aware that any change to the terms of an open-enrollment charter that relates to the following subjects
bull grade levels bullmaximum enrollment bull geographic boundaries bullapproved campus(es) bull approved sites bull relocation of campus bull charter holdername bull charter school (district) name bull charter campus name bull charter holder governance bull articles of incorporation bullcorporate bylaws bull management company bull admission policy or bullthe educational program of the school
requires the commissioner of educations approval ofan amendment (See sect1001033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadline for the submission ofapplicationsfor admission
Beginning ofPeriod (MonthDay) End of Period (MonthDay)
--~~~-M-ay_4__2_01_s~~~--I l__~~~M_a_y_1_a_2_0_1s~~~---
B If the school admits students by lottery when the number of admissions applications received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Aname (or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) Is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order in which they were drawn Notification of admission will be made and failure of a parent to respond within 48 hours of notification will forfeit his or her position in the lottery
C lfthe school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
0Yes
ONo
0 Not applicable (because lotteries are not utilized)
IfYes was indicated in C above state the categories of annlicants that are exempted
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Page 11
Section V (Continued)
Admission Policy
e school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be con led
Approximate Date of Lottery (MonthDay) ceuroSS ~ ~l-0
NA coll11lGeurolc
0ull-1lG E If the school does not utilize ottery when oversubscribed bu lleuroJSeuro~euroll-l ctole positions in the order in which
applications were received befo the expiration of the applicatil seuroeuro l 11e a first-come first-served admission process) describe the manner in ich the school notifies the ct bull 11unity of the opportunity to apply for admission TEC sect12 117 requires a charter sc of that uses ajirst-comefirst-served admission process when ove1mbscribed to publish a notice in a newspaper ofge1 ral circulation not later than the seventh day before the application deadline
Advertisements are published in the local newspap notifying the community of the Open-Enrollment Period for the school at least seven days before the close of the Ope Enrollment Period
F lfthe school has a separate process for re-enrollment state e process and the timeline to be used
he Re-Enrollment Period will begin May 4 2015 and end May 14 2 15 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 15 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the ignated window as listed above Students who could continue at their current campus but wish to transfer to a different mier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and o in a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application dea ine has passed
If an Application is received from an eligible applicant after the close of the open-enrollment p iod the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely ap ied
H Describe the infom1ation that an applicant must provide in order to be considered for admission Appi ants may not be required to provide copies of transcripts or other academic records until after they are offered od1 middotsion and are enrolling Furthermore a student may not be precluded ji-om enrolling due to the charter schools fail e to receive biformation required for enrollment ji-om the students parent or guardian or previous school See TEC sect2 002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date ofLottery (MonthDay)
0520 APPROVED DURING CONTINGENCY PROCESS
E If the school does not utilize a lottery when oversubscribed but rather fills the available positions in the order in which applications were received before the expiration ofthe application deadline (ie a first-come first-served admission process) describe the manner in which the school notifies the community of the opportunity to apply for admission TEC sect12117 requires a charter school that uses a first-come first-served admission process when oversubscribed to publish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
NIA
F If the school has a separate process for re-enrollment state the process and the timeline to be used
lfhe Re-Enrollment Period will begin May 4 2015 and end May 14 2015 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 2015 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the designated window as listed above Students who could continue at their current campus but wish to transfer to a different Premier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and obtain a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application deadline has passed
If an Application Is received from an eligible applicant after the close of the open-enrollment period the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
H Describe the information that an applicant must provide in order to be considered for admission Applicants may not be required to provide copies of transcripts or other academic records until after they are offered admission and are enrolling Furthermore a student may not be precluded from enrolling due to the charter schools failure to receive information required for enrollment from the students parent or guardian or previous school See TEC sect25002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
I The charter holder certifies that the non-discrimination statement required by TEC sectI2 I I I (a)(5) is printed in the schools admission policy TEC sect121 I I (a)(5) requires that a charter schools admission policy include a statement that the school will not discriminate in admissions based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend
0Ycs
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories ofa criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 3 7 Subchapter A as authorized by TEC sectI21 II (a)(5)(B)
0 Yes (The school excludes such students or reserves the right to exclude such students from admissions)
0 No (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bullA current copy of the admission policy that incorporates the information provided in the above answers to questions
A through H and any other relevant information (Attachment 3)
bull A blank copy of the current admission application ie the information requested when the student first seeks
admission (Attachment 4) and
bullA blank copy of the current enrollment form(s) ie the information required once an applicant has been offered
admission and is registering for enrollment (Attachment 5)
Page 13
I I
i
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
MEDINA VALLEY SD MELISSASD MERCEDES SD MERKELISD MESQUITE ISO MEXIAISD MEYERSVILLE ISO MIDLAND ISO MIDLOTHIAN ISO MIDWAY ISO MIDWAY ISO MILES SD MILFORD ISO MINEOLAISD MINERAL WELLS ISO MISSION CISD MONAHANS-WICKETI-PYOTE SD MONTE ALTO ISO MONTGOMERY ISO MOODY ISO MORGAN MILL ISO MOUNT PLEASANT SD MOUNT VERNON ISO MULESHOE SD NACOGDOCHES ISO NATALIA ISO NAVARRO ISO NAVASOTA SD NEDERLAND ISO NEEDVILLE ISO NEW BOSTON ISO NEW BRAUNFELS SD NEW CANEY SD NEW DEAL ISO NEW WAVERLY ISO NEWTON ISO NIXON-SMILEY CISD NORTH EAST ISO NORTH FOREST ISO NORTH LAMAR ISO NORTHSIDE ISO NORTHWEST ISO ODEM -EDROY ISO OGLESBY ISO OLNEY ISO ONALASKA ISO ORANGE GROVE ISO ORANGEFIELD ISO OVERTON ISO PALACIOS ISO PALESTINE ISO PALMER ISO PAMPA ISO PARIS ISO PASADENA ISO PEARLAND SD PEARSALL ISO PEASTERISD
PECOS-BARSTOW-TOYAH ISO PERRYTON ISO PETERSBURG ISO PETROLIA CISD PEWITTCISD PFLUGERVILLE ISO PHARR-SAN JUAN-ALAMOISD PILOT POINT ISO PINE TREE ISO PITTSBURG ISO PLAINVIEW ISO PLANO ISO PLEASANT GROVE ISO PLEASANTON SD POINT ISABEL ISO PONDER ISO POOLVILLE ISO PORT ARANSAS ISO PORT ARTHUR ISO PORT NECHES-GROVES ISO POTEET ISO POTISBORO ISO PRAJRILAND ISO PRESIDIO ISO PRINCETON ISO PROGRESO ISO PROSPER ISO QUINLAN ISO RANDOLPH FIELD SD RAYMONDVILLE ISO REDOAKISD REDWATER ISO RICHARDS ISO RICHARDSON ISO RIESEL ISO RIO GRANDE CITY CISD RlO HONDO ISO RlO VISTA ISO RJVER ROAD SD RJVERCREST ISO RIVIERA ISO ROBINSON ISO ROBSTOWN ISO ROCKDALE ISO ROCKWALL SD ROGERSISD ROMA ISO ROOSEVELTISO ROPES ISO ROSCOE COLLEGIATE SD ROUND ROCK SD ROXTON ISO ROYAL ISO ROYSE CITY SD RUSKISD SABINE PASS ISO SALADOISD SAN ANGELO ISO SAN ANTONIO ISO
SAN BENITO CISD SAN DIEGO ISO SAN ELIZARIO ISD SAN FELIPE-DEL RIO CISD SAN ISIDRO ISO SAN MARCOS CJSD SANGER ISO SANTA FE ISO SANTA MARIA ISO SANTA ROSA ISO SCHERTZ-ClBOLO-U CITY ISO SCURRY -ROSSER ISO SEALY ISO SEGUINISD SEMINOLE ISO SEYMOUR ISO SHALLOWATER ISO SHARYLAND ISO SHELDON ISO SHEPHERD ISO SHERMAN ISO SIDNEY ISO SILSBEE ISO SINTON ISO SLATON ISO SMITHVILLE SD SMYER ISO SNYDER ISO SOCORRO ISO SOMERSET SD SOUTH SAN ANTONIO ISO SOJTIJ TEXAS ISD SOUTHSIDE ISO SOUTHWEST SD SPLENDORA ISO SPRING BRANCH ISO SPRJNGISD SPRINGTOWN ISO SPURGER ISO STAFFORD MSD STAMFORD ISO STANTONISD STEPHENVILLE SD SULPHUR BLUFF ISO SULPHUR SPRlNGS ISO SUNNYVALE SD SWEENY ISO SWEETWATER ISO TAFTISD TAHOKAISD TARKINGTON ISD TAYLOR ISO TEAGUE ISO TEMPLEISD TERLINGUA CSD TERRELL COUNTY ISO TERRELLISD TEXARKANA ISO TEXAS CITY ISO
ATTACHMENT A
THRALLISD THREE WAY ISO TIDEHAVEN ISO TOLARISD TOM BEAN ISO TOMBALL ISO TORNJLLO SD TRENTISD TRINITY ISO TROUP ISO TROY ISO TULOSO-MIDWAY SD TYLERISD UNITEDISD UVALDECISD VALLEY MILLS ISO VALLEY VIEW ISO VALLEY VIEW SD VAN ALSTYNE ISO VAN ISO VAN VLECK SD VENUSISD VERlBEST ISO VERNONISD VICTORIA ISO VIDORISD VYSEHRAD ISO WACO ISO WALL ISO WALLERISD WARREN ISO WATER VALLEY ISO WAXAHACHIE ISO WEATHERFORD SD WESLACOISD WESTISD WEST ORANGE-COVE CISD WESTOSOISD WEST RUSK COUNTY CONSOLIDATED ISO WEST SABINE ISO WHITE SETILEMENT ISO WHITEHOUSE SD WHITESBORO ISO WHITNEY ISO WICHIT A FALLS ISO WILDORADO SD WILLIS ISO WILLS POINT SD WILSONISD WIMBERLEY ISO WINDTHORST SD WJNONAISD WOODVILLE ISO WYLIEISD WYLIE ISO YSLETAISD ZAPATA COUNTY ISO ZEPHYRISD
Table of Contents
Explanation of Renewal Process 4
Application Instructions 5
Selected Definitions 6
Application Sections
Section I Coversheet (Attachment A) 7 This is a printout of current charter holder information from the TEA Division of Charter School Administration database the CSTS and must be attached as the application coversheet (Attachment A)
Section II Contact Information 8 Requires the charter holder to provide the current contact information for the superintendent the charter holder board chair and the person who prepared the application
Section III Website Postings 9 Requires the charter holder to provide the homepage web address where the names of the members of the governing body are listed the web address where the superintendents salary is posted and web address where the charter financial statements are continuously posted as required by Local Government Code sect140006
Section IV Organizational Charts 10 Requires the charter holder to provide the organizational chart of the charter school as well as a chart showing other entities and programs managed by the charter holder This section requires the submission of attachments 1and 2
Section V Admission Policy 11 Requires the charter holder to provide details concerning the charter schools admission policy and practices In addition this section requires the submission of attachments 3 4 and 5
Section VI Special Education Assurances 14 Requires the charter holder to certify that it has policies and procedures in place that ensure implementation ofall federal Jaws and regulations Texas laws State Board of Education rules and commissioner rules related to students with disabilities and further assures that any future amendments to the regulations Jaws and rules will be incorporated and implemented This section must be signed by the charter holder board chair
Section VII Serving Students at Residential Facilities Assurances 15 This section is required only when the charter educates students at a residential facility Requires the charter holder to certify that it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education rules and commissioner rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the Jaws regulations and rules will be incorporated and implemented If required this section must be signed by the charter holder board chair
Section VIII BilingualESL Section 504 and Dyslexia Assurances 17 Requires the charter holder to certify that it has policies and procedures in place ensuring that it complies with the legal and regulatory requirements concerning identifying and providing appropriate education services to limited English proficient students students protected by Section 504 of the Rehabilitation Act of 1973 and students with dyslexia or related disorders This section must be completed and signed by the charter holder board chair
Page 2
Section IX Fingerprinting and Criminal Record Check Assurance 18 Requires the charter holder to certify that it is in compliance with TEC sect 12120 and confirms that no individual is serving in any capacity ifhe or she has been convicted ofa misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code of Criminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Section X Certificate of Acknowledgement 19 Requires at least a majority of the governing body of the charter holder to certify that it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of the renewal of the charter
Texas Education Agency Contact Information 20
Renewal Process Flowchart 21
Attachments Required of Applicant
Charter School Organizational Chart (Attachment I)
Charter Holder Organizational Chart (Attachment 2)
Admission Policy (Attachment 3)
Admission Application (Attachment 4)
Enrollment Form (Attachment 5)
Pagc3
Explanation of Renewal Process
19 Texas Administrative Code (TAC) sectI 00 103J contains additional information about charter renewal
The renewal process is separate from the charter amendment process Significant changes from the original charter should not be made in the renewal application unless a charter amendment has been previously approved
As authorized in Texas Education Code (TEC) sect121141 the commissioners procedures for renewal must include three distinct processes expedited renewal discretionary renewal and expiration
Definitions of the three renewal processes
Expedited (30 days) If in the preceding 3 years bull Highest or second highest academic performance rating bull Satisfactory or higher financial rating and bull No campus has been assigned the lowest rating or no campus has been closed for low ratings
Discretionary (90 days) Consideration among others of bullAcademic Performance 2009-2010 2010-2011 2012-2013 2013-2014 bull Financial Ratings 2009-2010 20I0-2011 2011-2012 2012-2013 2013-2014 bullPerformance Framework (TEC sect121181)
Expiration (30 day notification) If for any 3 of the 5 preceding school years bull Lowest academic performance rating bull Lower than satisfactory financial rating bull The charter was assigned any combination of ratings or bull A campus has been assigned the lowest performance rating for the 3 preceding school years and has not been closed
The due date for charters to submit the completed renewal application to the Texas Education Agency (TEA) is Wednesday January 7 2015
You may request an informal review of the findings and actions described in this letter by sending a written request to
Brandon Spenrath Program Specialist Charter School Administration Texas Education Agency 170 I North Congress Ave Austin Texas 7870 I Fax (512) 936-9281 brand on spen rat h(iitea state tx us
The request must be received no later than Wednesday December 17 2014 Your request must identify what changes you are requesting the reasons for your request and documentation to support your request If we do not receive your request before the deadline final action will be taken without further review
Please see 19 TAC Chapter 157 subchapter EE Division I for addition information about the informal review process
Pagc4
Application Instructions
The renewal application contains ten sections to be completed electronically printed into hardcopy form for required signatures and dates and submitted on or before the due date to the Division ofCharter School Administration
1 Deadline The completed application must be returned by mail to the Division ofCharter School Administration by Wednesday January 7 2015
2 Typing Requirement All of the responses to the application sections with the exception ofsignatures and dates of signatures must be typed
3 Printing Requirement The application must be printed on one-sided 8 I 2 x 11 white paper
4 Signature Requirement Where signatures and dates ofsignatures are required they must be in blue ink
5 Submission of Original Document and One Copy The completed and unbound (rubber bands or clips are acceptable) original renewal application including fillable forms and attachments and one additional copy must be submitted as follows
Texas Education Agency Division ofCharter School Administration
170 I North Congress A venue Austin Texas 7870 I
Page 5
Selected Definitions
Please review TEC sect12 I OJ 2 and 19 TAC sect1001001 for definitions of terms which are available at the education laws and mies page Listed below are selected terms and definitions
bull Charter holder - the entity to which a charter is granted under TEC Chapter 12
bull Charter school - a Texas public school operated by a charter holder under an open-enrollment charter granted by the commissioner n pursuant to TEC sect12 J01
Governing body ofa charter holder - the board of directors board of tmstees or other governing body of a charter holder
bull Governing body ofa charter school - the board of directors board of trustees or other governing body of an open-enrollment charter school the term includes the governing body ofa charter holder ifthat body acts as the governing body of the open-enrollment charter school
bull Management company - a person or entity other than a charter holder that provides management services for an open-enrollment charter school
bull Officer ofa charter school - the principal director or other chief operating officer of an open-enrollment charter school an assistant principal or assistant director of an open-enrollment charter school or a person charged with managing the finances ofan open-enrollment charter school
bull Board chair or chaitperson - generally the board president or presiding officer of the governing board
Page 6
Section I
Coversheet
ATTACHMENT A OPEN-ENROLLMENT CHARTER CONTRACT RENEWAL
The enclosed document entitled OPEN-ENROLLMENT CHARTER CONTRACT RENEW AL will serve as the coversheet when the application is completed and submitted and includes current information in the Charter School Tracking System Verify the accuracy of the information on the coversheet and if updates to the information are needed create a separate sheet detailing your corrections and label the sheet Update to Data Provided by TEA and include it in the renewal packet immediately following the preprinted coversheet
Pagc7
Section II
Contact Information
The persons listed below will be contacted by agency staff ifthere are issues to be resolved in any ofthe renewal application sections Note that any contact information including email addresses provided with the renewal application will be public information
Superintendent Contact Information
Superintendents Name lcharles Cook
=============================================== Telephone Number 1(972) 316-3663
=============================================== Fax Number 1972-315-9506
=========================================~ E-mail Address lccookresponsiveedcom
Charter Holder Board Chair Contact Information
Board Chairs Name Marvin Reynolds
Telephone Number 1866-605-7772
Fax Number 1972-315-9506
E-mail Address leducatenationalhomeschoolcom
Application Preparers Contact Information El Same as Superintendent D Same as Board Chair
Contact Name lcharles Cook
Telephone Number 1(972) 316-3663
Fax Number 1972-315-9506
E-mail Address lccookresponsiveedcom
Charter School Website
Web address lhttppremierhighschoolscom
Page 8
Section III
Website Postings
In accordance with the requirements of TEC sect12 1211 an open-enrollment charter school shall list the names of the members of the governing body on the home page of the schools internet website Provide the internet URL address where the names of the members of the governing body are listed
httppremierhighschoolscomtexas-state-requi red-information
In accordance with the requirements of TEC sect12 136 an open-enrollment charter school shall post the salary of the schools superintendent or CEO on the schools internet website Provide the internet URL address where the superintendents salary is posted
httppremierhighschoolscomtexas-state-required-information
In accordance with Local Government Code sect140006 an open-enrollment charter school shall post continuously on the schools internet website the annual financials of the school Provide the internet URL address where the annual financial statements of the charter school are continuously posted
httppremierhighschoolscomtexas-state-required-information
Page9
Section IV
Organizational Charts
Submit as Attachment 1 the organizational chart for the charter school that specifies the administrative positions including the title and name of the individual currently in each position
Submit as Attachment 2 a chart that identifies all other entities under the direction of the charter holder This would include entities andor programs that the charter holder governsmanages in addition to the charter school
Page 10
I I
I I
I
middot~middot==middot==middotmiddotmiddotmiddot~~ Robert Davison liChief Operating O~cj
~1~ middotmiddotmiddotmiddotmiddotmiddot shyOr Mary Ann Duncan Gary Arnold Corey Thomas
VP-School VP - Human InformationI Operations I Resources Technology (IT)
--~~1~-- ---~~~
middotmiddotmiddotmiddotmiddotmiddot-middot -middot~ ----- shy
Kim OLeary PEIMS
ResponsiveEdPremier High Schools
Board of Directors
Chuck Cook Superintendent I
Chief Executive Officer
I Chris eaumaOn bull
General Counsel IVP - Business Oevelooment I
I ~--------1~ -middotmiddotmiddotmiddotmiddot ~ I
Jeffrie Evans Terri Baumann Brian Stevens carrie Alexander
Marketing amp Curriculum Facilities VP - Finance
Communications Development
I I
Regional Directors of Regional Directors of Operations Academics
campus Directors shyPremier High School shy
Premier High School Campus Staff
I
Or Alan Wimberley Chief Education
Architect
I I
Wesley Cockrum I=Software Kyle Queal
Development - Academics -----I_____
I
I
Responsive Education bullt--------------------------iI R~~~i~~=~~~~=~1Solutions
=~~~~~ I
1rmiddot~middot=middotmiddotmiddot=middot~-~--~middot-I Texas Education
Texas Education Indianapolis MayorsAustin Independent llAgency- Texas College Ohio Council ofd~~Amiddotdcp_p1 [~~
I
Agency- Premier High Office of EducationSchool District - 2 Preparatory Community Schools I State Board of Schools Charter Innovation - 1 School
Sites Academies Charter -5 Schoolsf roved I II Education -4 Charters District - 32 Sites ApprovedI District - 33 Sites Approved
l_ I n=li=middot
I ===-middotmiddot--middot
Section V
Admission Policy
Pie e be aware that any change to the terms ofan open-enrollment charter that relates to the following subjects
ade levels bullma middotmum enrollment
hie boundaries bullapprove ampus(es) bull approved s s bull relocation of bull charter holder n e bullcharter school (dis ct) name bull charter campus name bullcharter holder goveman bull articles of incorporation bull corporate bylaws bullmanagement company bull admission policy or bull the educational program of the sch
requires the commissioner ofeducations approva fan amendment (See sectI00 1033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admis middot n are accepted TEC sectI2117 requires that a charter school establish a reasonable application deadline for the 1bmission ofapplications for admission
Beginning of Period (MonthDay)
May4 2015
B If the school admits students by lottery when the number of admissions ap middotcations received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Not applicable
C If the school utilizes a lottery when oversubscribed are any categories ofapplicants exempted from th lottery
0Ycs
0No
0 Not applicable (because lotteries arc not utilized)
If Yes was indicated in C above state the categories ofapplicants that are exempted
Page 11
Section V
Admission Policy
Please be aware that any change to the terms of an open-enrollment charter that relates to the following subjects
bull grade levels bullmaximum enrollment bull geographic boundaries bullapproved campus(es) bull approved sites bull relocation of campus bull charter holdername bull charter school (district) name bull charter campus name bull charter holder governance bull articles of incorporation bullcorporate bylaws bull management company bull admission policy or bullthe educational program of the school
requires the commissioner of educations approval ofan amendment (See sect1001033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadline for the submission ofapplicationsfor admission
Beginning ofPeriod (MonthDay) End of Period (MonthDay)
--~~~-M-ay_4__2_01_s~~~--I l__~~~M_a_y_1_a_2_0_1s~~~---
B If the school admits students by lottery when the number of admissions applications received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Aname (or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) Is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order in which they were drawn Notification of admission will be made and failure of a parent to respond within 48 hours of notification will forfeit his or her position in the lottery
C lfthe school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
0Yes
ONo
0 Not applicable (because lotteries are not utilized)
IfYes was indicated in C above state the categories of annlicants that are exempted
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Page 11
Section V (Continued)
Admission Policy
e school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be con led
Approximate Date of Lottery (MonthDay) ceuroSS ~ ~l-0
NA coll11lGeurolc
0ull-1lG E If the school does not utilize ottery when oversubscribed bu lleuroJSeuro~euroll-l ctole positions in the order in which
applications were received befo the expiration of the applicatil seuroeuro l 11e a first-come first-served admission process) describe the manner in ich the school notifies the ct bull 11unity of the opportunity to apply for admission TEC sect12 117 requires a charter sc of that uses ajirst-comefirst-served admission process when ove1mbscribed to publish a notice in a newspaper ofge1 ral circulation not later than the seventh day before the application deadline
Advertisements are published in the local newspap notifying the community of the Open-Enrollment Period for the school at least seven days before the close of the Ope Enrollment Period
F lfthe school has a separate process for re-enrollment state e process and the timeline to be used
he Re-Enrollment Period will begin May 4 2015 and end May 14 2 15 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 15 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the ignated window as listed above Students who could continue at their current campus but wish to transfer to a different mier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and o in a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application dea ine has passed
If an Application is received from an eligible applicant after the close of the open-enrollment p iod the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely ap ied
H Describe the infom1ation that an applicant must provide in order to be considered for admission Appi ants may not be required to provide copies of transcripts or other academic records until after they are offered od1 middotsion and are enrolling Furthermore a student may not be precluded ji-om enrolling due to the charter schools fail e to receive biformation required for enrollment ji-om the students parent or guardian or previous school See TEC sect2 002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date ofLottery (MonthDay)
0520 APPROVED DURING CONTINGENCY PROCESS
E If the school does not utilize a lottery when oversubscribed but rather fills the available positions in the order in which applications were received before the expiration ofthe application deadline (ie a first-come first-served admission process) describe the manner in which the school notifies the community of the opportunity to apply for admission TEC sect12117 requires a charter school that uses a first-come first-served admission process when oversubscribed to publish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
NIA
F If the school has a separate process for re-enrollment state the process and the timeline to be used
lfhe Re-Enrollment Period will begin May 4 2015 and end May 14 2015 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 2015 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the designated window as listed above Students who could continue at their current campus but wish to transfer to a different Premier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and obtain a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application deadline has passed
If an Application Is received from an eligible applicant after the close of the open-enrollment period the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
H Describe the information that an applicant must provide in order to be considered for admission Applicants may not be required to provide copies of transcripts or other academic records until after they are offered admission and are enrolling Furthermore a student may not be precluded from enrolling due to the charter schools failure to receive information required for enrollment from the students parent or guardian or previous school See TEC sect25002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
I The charter holder certifies that the non-discrimination statement required by TEC sectI2 I I I (a)(5) is printed in the schools admission policy TEC sect121 I I (a)(5) requires that a charter schools admission policy include a statement that the school will not discriminate in admissions based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend
0Ycs
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories ofa criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 3 7 Subchapter A as authorized by TEC sectI21 II (a)(5)(B)
0 Yes (The school excludes such students or reserves the right to exclude such students from admissions)
0 No (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bullA current copy of the admission policy that incorporates the information provided in the above answers to questions
A through H and any other relevant information (Attachment 3)
bull A blank copy of the current admission application ie the information requested when the student first seeks
admission (Attachment 4) and
bullA blank copy of the current enrollment form(s) ie the information required once an applicant has been offered
admission and is registering for enrollment (Attachment 5)
Page 13
I I
i
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Table of Contents
Explanation of Renewal Process 4
Application Instructions 5
Selected Definitions 6
Application Sections
Section I Coversheet (Attachment A) 7 This is a printout of current charter holder information from the TEA Division of Charter School Administration database the CSTS and must be attached as the application coversheet (Attachment A)
Section II Contact Information 8 Requires the charter holder to provide the current contact information for the superintendent the charter holder board chair and the person who prepared the application
Section III Website Postings 9 Requires the charter holder to provide the homepage web address where the names of the members of the governing body are listed the web address where the superintendents salary is posted and web address where the charter financial statements are continuously posted as required by Local Government Code sect140006
Section IV Organizational Charts 10 Requires the charter holder to provide the organizational chart of the charter school as well as a chart showing other entities and programs managed by the charter holder This section requires the submission of attachments 1and 2
Section V Admission Policy 11 Requires the charter holder to provide details concerning the charter schools admission policy and practices In addition this section requires the submission of attachments 3 4 and 5
Section VI Special Education Assurances 14 Requires the charter holder to certify that it has policies and procedures in place that ensure implementation ofall federal Jaws and regulations Texas laws State Board of Education rules and commissioner rules related to students with disabilities and further assures that any future amendments to the regulations Jaws and rules will be incorporated and implemented This section must be signed by the charter holder board chair
Section VII Serving Students at Residential Facilities Assurances 15 This section is required only when the charter educates students at a residential facility Requires the charter holder to certify that it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education rules and commissioner rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the Jaws regulations and rules will be incorporated and implemented If required this section must be signed by the charter holder board chair
Section VIII BilingualESL Section 504 and Dyslexia Assurances 17 Requires the charter holder to certify that it has policies and procedures in place ensuring that it complies with the legal and regulatory requirements concerning identifying and providing appropriate education services to limited English proficient students students protected by Section 504 of the Rehabilitation Act of 1973 and students with dyslexia or related disorders This section must be completed and signed by the charter holder board chair
Page 2
Section IX Fingerprinting and Criminal Record Check Assurance 18 Requires the charter holder to certify that it is in compliance with TEC sect 12120 and confirms that no individual is serving in any capacity ifhe or she has been convicted ofa misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code of Criminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Section X Certificate of Acknowledgement 19 Requires at least a majority of the governing body of the charter holder to certify that it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of the renewal of the charter
Texas Education Agency Contact Information 20
Renewal Process Flowchart 21
Attachments Required of Applicant
Charter School Organizational Chart (Attachment I)
Charter Holder Organizational Chart (Attachment 2)
Admission Policy (Attachment 3)
Admission Application (Attachment 4)
Enrollment Form (Attachment 5)
Pagc3
Explanation of Renewal Process
19 Texas Administrative Code (TAC) sectI 00 103J contains additional information about charter renewal
The renewal process is separate from the charter amendment process Significant changes from the original charter should not be made in the renewal application unless a charter amendment has been previously approved
As authorized in Texas Education Code (TEC) sect121141 the commissioners procedures for renewal must include three distinct processes expedited renewal discretionary renewal and expiration
Definitions of the three renewal processes
Expedited (30 days) If in the preceding 3 years bull Highest or second highest academic performance rating bull Satisfactory or higher financial rating and bull No campus has been assigned the lowest rating or no campus has been closed for low ratings
Discretionary (90 days) Consideration among others of bullAcademic Performance 2009-2010 2010-2011 2012-2013 2013-2014 bull Financial Ratings 2009-2010 20I0-2011 2011-2012 2012-2013 2013-2014 bullPerformance Framework (TEC sect121181)
Expiration (30 day notification) If for any 3 of the 5 preceding school years bull Lowest academic performance rating bull Lower than satisfactory financial rating bull The charter was assigned any combination of ratings or bull A campus has been assigned the lowest performance rating for the 3 preceding school years and has not been closed
The due date for charters to submit the completed renewal application to the Texas Education Agency (TEA) is Wednesday January 7 2015
You may request an informal review of the findings and actions described in this letter by sending a written request to
Brandon Spenrath Program Specialist Charter School Administration Texas Education Agency 170 I North Congress Ave Austin Texas 7870 I Fax (512) 936-9281 brand on spen rat h(iitea state tx us
The request must be received no later than Wednesday December 17 2014 Your request must identify what changes you are requesting the reasons for your request and documentation to support your request If we do not receive your request before the deadline final action will be taken without further review
Please see 19 TAC Chapter 157 subchapter EE Division I for addition information about the informal review process
Pagc4
Application Instructions
The renewal application contains ten sections to be completed electronically printed into hardcopy form for required signatures and dates and submitted on or before the due date to the Division ofCharter School Administration
1 Deadline The completed application must be returned by mail to the Division ofCharter School Administration by Wednesday January 7 2015
2 Typing Requirement All of the responses to the application sections with the exception ofsignatures and dates of signatures must be typed
3 Printing Requirement The application must be printed on one-sided 8 I 2 x 11 white paper
4 Signature Requirement Where signatures and dates ofsignatures are required they must be in blue ink
5 Submission of Original Document and One Copy The completed and unbound (rubber bands or clips are acceptable) original renewal application including fillable forms and attachments and one additional copy must be submitted as follows
Texas Education Agency Division ofCharter School Administration
170 I North Congress A venue Austin Texas 7870 I
Page 5
Selected Definitions
Please review TEC sect12 I OJ 2 and 19 TAC sect1001001 for definitions of terms which are available at the education laws and mies page Listed below are selected terms and definitions
bull Charter holder - the entity to which a charter is granted under TEC Chapter 12
bull Charter school - a Texas public school operated by a charter holder under an open-enrollment charter granted by the commissioner n pursuant to TEC sect12 J01
Governing body ofa charter holder - the board of directors board of tmstees or other governing body of a charter holder
bull Governing body ofa charter school - the board of directors board of trustees or other governing body of an open-enrollment charter school the term includes the governing body ofa charter holder ifthat body acts as the governing body of the open-enrollment charter school
bull Management company - a person or entity other than a charter holder that provides management services for an open-enrollment charter school
bull Officer ofa charter school - the principal director or other chief operating officer of an open-enrollment charter school an assistant principal or assistant director of an open-enrollment charter school or a person charged with managing the finances ofan open-enrollment charter school
bull Board chair or chaitperson - generally the board president or presiding officer of the governing board
Page 6
Section I
Coversheet
ATTACHMENT A OPEN-ENROLLMENT CHARTER CONTRACT RENEWAL
The enclosed document entitled OPEN-ENROLLMENT CHARTER CONTRACT RENEW AL will serve as the coversheet when the application is completed and submitted and includes current information in the Charter School Tracking System Verify the accuracy of the information on the coversheet and if updates to the information are needed create a separate sheet detailing your corrections and label the sheet Update to Data Provided by TEA and include it in the renewal packet immediately following the preprinted coversheet
Pagc7
Section II
Contact Information
The persons listed below will be contacted by agency staff ifthere are issues to be resolved in any ofthe renewal application sections Note that any contact information including email addresses provided with the renewal application will be public information
Superintendent Contact Information
Superintendents Name lcharles Cook
=============================================== Telephone Number 1(972) 316-3663
=============================================== Fax Number 1972-315-9506
=========================================~ E-mail Address lccookresponsiveedcom
Charter Holder Board Chair Contact Information
Board Chairs Name Marvin Reynolds
Telephone Number 1866-605-7772
Fax Number 1972-315-9506
E-mail Address leducatenationalhomeschoolcom
Application Preparers Contact Information El Same as Superintendent D Same as Board Chair
Contact Name lcharles Cook
Telephone Number 1(972) 316-3663
Fax Number 1972-315-9506
E-mail Address lccookresponsiveedcom
Charter School Website
Web address lhttppremierhighschoolscom
Page 8
Section III
Website Postings
In accordance with the requirements of TEC sect12 1211 an open-enrollment charter school shall list the names of the members of the governing body on the home page of the schools internet website Provide the internet URL address where the names of the members of the governing body are listed
httppremierhighschoolscomtexas-state-requi red-information
In accordance with the requirements of TEC sect12 136 an open-enrollment charter school shall post the salary of the schools superintendent or CEO on the schools internet website Provide the internet URL address where the superintendents salary is posted
httppremierhighschoolscomtexas-state-required-information
In accordance with Local Government Code sect140006 an open-enrollment charter school shall post continuously on the schools internet website the annual financials of the school Provide the internet URL address where the annual financial statements of the charter school are continuously posted
httppremierhighschoolscomtexas-state-required-information
Page9
Section IV
Organizational Charts
Submit as Attachment 1 the organizational chart for the charter school that specifies the administrative positions including the title and name of the individual currently in each position
Submit as Attachment 2 a chart that identifies all other entities under the direction of the charter holder This would include entities andor programs that the charter holder governsmanages in addition to the charter school
Page 10
I I
I I
I
middot~middot==middot==middotmiddotmiddotmiddot~~ Robert Davison liChief Operating O~cj
~1~ middotmiddotmiddotmiddotmiddotmiddot shyOr Mary Ann Duncan Gary Arnold Corey Thomas
VP-School VP - Human InformationI Operations I Resources Technology (IT)
--~~1~-- ---~~~
middotmiddotmiddotmiddotmiddotmiddot-middot -middot~ ----- shy
Kim OLeary PEIMS
ResponsiveEdPremier High Schools
Board of Directors
Chuck Cook Superintendent I
Chief Executive Officer
I Chris eaumaOn bull
General Counsel IVP - Business Oevelooment I
I ~--------1~ -middotmiddotmiddotmiddotmiddot ~ I
Jeffrie Evans Terri Baumann Brian Stevens carrie Alexander
Marketing amp Curriculum Facilities VP - Finance
Communications Development
I I
Regional Directors of Regional Directors of Operations Academics
campus Directors shyPremier High School shy
Premier High School Campus Staff
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Or Alan Wimberley Chief Education
Architect
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Wesley Cockrum I=Software Kyle Queal
Development - Academics -----I_____
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Responsive Education bullt--------------------------iI R~~~i~~=~~~~=~1Solutions
=~~~~~ I
1rmiddot~middot=middotmiddotmiddot=middot~-~--~middot-I Texas Education
Texas Education Indianapolis MayorsAustin Independent llAgency- Texas College Ohio Council ofd~~Amiddotdcp_p1 [~~
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Agency- Premier High Office of EducationSchool District - 2 Preparatory Community Schools I State Board of Schools Charter Innovation - 1 School
Sites Academies Charter -5 Schoolsf roved I II Education -4 Charters District - 32 Sites ApprovedI District - 33 Sites Approved
l_ I n=li=middot
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Section V
Admission Policy
Pie e be aware that any change to the terms ofan open-enrollment charter that relates to the following subjects
ade levels bullma middotmum enrollment
hie boundaries bullapprove ampus(es) bull approved s s bull relocation of bull charter holder n e bullcharter school (dis ct) name bull charter campus name bullcharter holder goveman bull articles of incorporation bull corporate bylaws bullmanagement company bull admission policy or bull the educational program of the sch
requires the commissioner ofeducations approva fan amendment (See sectI00 1033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admis middot n are accepted TEC sectI2117 requires that a charter school establish a reasonable application deadline for the 1bmission ofapplications for admission
Beginning of Period (MonthDay)
May4 2015
B If the school admits students by lottery when the number of admissions ap middotcations received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Not applicable
C If the school utilizes a lottery when oversubscribed are any categories ofapplicants exempted from th lottery
0Ycs
0No
0 Not applicable (because lotteries arc not utilized)
If Yes was indicated in C above state the categories ofapplicants that are exempted
Page 11
Section V
Admission Policy
Please be aware that any change to the terms of an open-enrollment charter that relates to the following subjects
bull grade levels bullmaximum enrollment bull geographic boundaries bullapproved campus(es) bull approved sites bull relocation of campus bull charter holdername bull charter school (district) name bull charter campus name bull charter holder governance bull articles of incorporation bullcorporate bylaws bull management company bull admission policy or bullthe educational program of the school
requires the commissioner of educations approval ofan amendment (See sect1001033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadline for the submission ofapplicationsfor admission
Beginning ofPeriod (MonthDay) End of Period (MonthDay)
--~~~-M-ay_4__2_01_s~~~--I l__~~~M_a_y_1_a_2_0_1s~~~---
B If the school admits students by lottery when the number of admissions applications received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Aname (or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) Is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order in which they were drawn Notification of admission will be made and failure of a parent to respond within 48 hours of notification will forfeit his or her position in the lottery
C lfthe school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
0Yes
ONo
0 Not applicable (because lotteries are not utilized)
IfYes was indicated in C above state the categories of annlicants that are exempted
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Page 11
Section V (Continued)
Admission Policy
e school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be con led
Approximate Date of Lottery (MonthDay) ceuroSS ~ ~l-0
NA coll11lGeurolc
0ull-1lG E If the school does not utilize ottery when oversubscribed bu lleuroJSeuro~euroll-l ctole positions in the order in which
applications were received befo the expiration of the applicatil seuroeuro l 11e a first-come first-served admission process) describe the manner in ich the school notifies the ct bull 11unity of the opportunity to apply for admission TEC sect12 117 requires a charter sc of that uses ajirst-comefirst-served admission process when ove1mbscribed to publish a notice in a newspaper ofge1 ral circulation not later than the seventh day before the application deadline
Advertisements are published in the local newspap notifying the community of the Open-Enrollment Period for the school at least seven days before the close of the Ope Enrollment Period
F lfthe school has a separate process for re-enrollment state e process and the timeline to be used
he Re-Enrollment Period will begin May 4 2015 and end May 14 2 15 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 15 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the ignated window as listed above Students who could continue at their current campus but wish to transfer to a different mier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and o in a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application dea ine has passed
If an Application is received from an eligible applicant after the close of the open-enrollment p iod the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely ap ied
H Describe the infom1ation that an applicant must provide in order to be considered for admission Appi ants may not be required to provide copies of transcripts or other academic records until after they are offered od1 middotsion and are enrolling Furthermore a student may not be precluded ji-om enrolling due to the charter schools fail e to receive biformation required for enrollment ji-om the students parent or guardian or previous school See TEC sect2 002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date ofLottery (MonthDay)
0520 APPROVED DURING CONTINGENCY PROCESS
E If the school does not utilize a lottery when oversubscribed but rather fills the available positions in the order in which applications were received before the expiration ofthe application deadline (ie a first-come first-served admission process) describe the manner in which the school notifies the community of the opportunity to apply for admission TEC sect12117 requires a charter school that uses a first-come first-served admission process when oversubscribed to publish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
NIA
F If the school has a separate process for re-enrollment state the process and the timeline to be used
lfhe Re-Enrollment Period will begin May 4 2015 and end May 14 2015 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 2015 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the designated window as listed above Students who could continue at their current campus but wish to transfer to a different Premier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and obtain a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application deadline has passed
If an Application Is received from an eligible applicant after the close of the open-enrollment period the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
H Describe the information that an applicant must provide in order to be considered for admission Applicants may not be required to provide copies of transcripts or other academic records until after they are offered admission and are enrolling Furthermore a student may not be precluded from enrolling due to the charter schools failure to receive information required for enrollment from the students parent or guardian or previous school See TEC sect25002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
I The charter holder certifies that the non-discrimination statement required by TEC sectI2 I I I (a)(5) is printed in the schools admission policy TEC sect121 I I (a)(5) requires that a charter schools admission policy include a statement that the school will not discriminate in admissions based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend
0Ycs
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories ofa criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 3 7 Subchapter A as authorized by TEC sectI21 II (a)(5)(B)
0 Yes (The school excludes such students or reserves the right to exclude such students from admissions)
0 No (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bullA current copy of the admission policy that incorporates the information provided in the above answers to questions
A through H and any other relevant information (Attachment 3)
bull A blank copy of the current admission application ie the information requested when the student first seeks
admission (Attachment 4) and
bullA blank copy of the current enrollment form(s) ie the information required once an applicant has been offered
admission and is registering for enrollment (Attachment 5)
Page 13
I I
i
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Section IX Fingerprinting and Criminal Record Check Assurance 18 Requires the charter holder to certify that it is in compliance with TEC sect 12120 and confirms that no individual is serving in any capacity ifhe or she has been convicted ofa misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code of Criminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Section X Certificate of Acknowledgement 19 Requires at least a majority of the governing body of the charter holder to certify that it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of the renewal of the charter
Texas Education Agency Contact Information 20
Renewal Process Flowchart 21
Attachments Required of Applicant
Charter School Organizational Chart (Attachment I)
Charter Holder Organizational Chart (Attachment 2)
Admission Policy (Attachment 3)
Admission Application (Attachment 4)
Enrollment Form (Attachment 5)
Pagc3
Explanation of Renewal Process
19 Texas Administrative Code (TAC) sectI 00 103J contains additional information about charter renewal
The renewal process is separate from the charter amendment process Significant changes from the original charter should not be made in the renewal application unless a charter amendment has been previously approved
As authorized in Texas Education Code (TEC) sect121141 the commissioners procedures for renewal must include three distinct processes expedited renewal discretionary renewal and expiration
Definitions of the three renewal processes
Expedited (30 days) If in the preceding 3 years bull Highest or second highest academic performance rating bull Satisfactory or higher financial rating and bull No campus has been assigned the lowest rating or no campus has been closed for low ratings
Discretionary (90 days) Consideration among others of bullAcademic Performance 2009-2010 2010-2011 2012-2013 2013-2014 bull Financial Ratings 2009-2010 20I0-2011 2011-2012 2012-2013 2013-2014 bullPerformance Framework (TEC sect121181)
Expiration (30 day notification) If for any 3 of the 5 preceding school years bull Lowest academic performance rating bull Lower than satisfactory financial rating bull The charter was assigned any combination of ratings or bull A campus has been assigned the lowest performance rating for the 3 preceding school years and has not been closed
The due date for charters to submit the completed renewal application to the Texas Education Agency (TEA) is Wednesday January 7 2015
You may request an informal review of the findings and actions described in this letter by sending a written request to
Brandon Spenrath Program Specialist Charter School Administration Texas Education Agency 170 I North Congress Ave Austin Texas 7870 I Fax (512) 936-9281 brand on spen rat h(iitea state tx us
The request must be received no later than Wednesday December 17 2014 Your request must identify what changes you are requesting the reasons for your request and documentation to support your request If we do not receive your request before the deadline final action will be taken without further review
Please see 19 TAC Chapter 157 subchapter EE Division I for addition information about the informal review process
Pagc4
Application Instructions
The renewal application contains ten sections to be completed electronically printed into hardcopy form for required signatures and dates and submitted on or before the due date to the Division ofCharter School Administration
1 Deadline The completed application must be returned by mail to the Division ofCharter School Administration by Wednesday January 7 2015
2 Typing Requirement All of the responses to the application sections with the exception ofsignatures and dates of signatures must be typed
3 Printing Requirement The application must be printed on one-sided 8 I 2 x 11 white paper
4 Signature Requirement Where signatures and dates ofsignatures are required they must be in blue ink
5 Submission of Original Document and One Copy The completed and unbound (rubber bands or clips are acceptable) original renewal application including fillable forms and attachments and one additional copy must be submitted as follows
Texas Education Agency Division ofCharter School Administration
170 I North Congress A venue Austin Texas 7870 I
Page 5
Selected Definitions
Please review TEC sect12 I OJ 2 and 19 TAC sect1001001 for definitions of terms which are available at the education laws and mies page Listed below are selected terms and definitions
bull Charter holder - the entity to which a charter is granted under TEC Chapter 12
bull Charter school - a Texas public school operated by a charter holder under an open-enrollment charter granted by the commissioner n pursuant to TEC sect12 J01
Governing body ofa charter holder - the board of directors board of tmstees or other governing body of a charter holder
bull Governing body ofa charter school - the board of directors board of trustees or other governing body of an open-enrollment charter school the term includes the governing body ofa charter holder ifthat body acts as the governing body of the open-enrollment charter school
bull Management company - a person or entity other than a charter holder that provides management services for an open-enrollment charter school
bull Officer ofa charter school - the principal director or other chief operating officer of an open-enrollment charter school an assistant principal or assistant director of an open-enrollment charter school or a person charged with managing the finances ofan open-enrollment charter school
bull Board chair or chaitperson - generally the board president or presiding officer of the governing board
Page 6
Section I
Coversheet
ATTACHMENT A OPEN-ENROLLMENT CHARTER CONTRACT RENEWAL
The enclosed document entitled OPEN-ENROLLMENT CHARTER CONTRACT RENEW AL will serve as the coversheet when the application is completed and submitted and includes current information in the Charter School Tracking System Verify the accuracy of the information on the coversheet and if updates to the information are needed create a separate sheet detailing your corrections and label the sheet Update to Data Provided by TEA and include it in the renewal packet immediately following the preprinted coversheet
Pagc7
Section II
Contact Information
The persons listed below will be contacted by agency staff ifthere are issues to be resolved in any ofthe renewal application sections Note that any contact information including email addresses provided with the renewal application will be public information
Superintendent Contact Information
Superintendents Name lcharles Cook
=============================================== Telephone Number 1(972) 316-3663
=============================================== Fax Number 1972-315-9506
=========================================~ E-mail Address lccookresponsiveedcom
Charter Holder Board Chair Contact Information
Board Chairs Name Marvin Reynolds
Telephone Number 1866-605-7772
Fax Number 1972-315-9506
E-mail Address leducatenationalhomeschoolcom
Application Preparers Contact Information El Same as Superintendent D Same as Board Chair
Contact Name lcharles Cook
Telephone Number 1(972) 316-3663
Fax Number 1972-315-9506
E-mail Address lccookresponsiveedcom
Charter School Website
Web address lhttppremierhighschoolscom
Page 8
Section III
Website Postings
In accordance with the requirements of TEC sect12 1211 an open-enrollment charter school shall list the names of the members of the governing body on the home page of the schools internet website Provide the internet URL address where the names of the members of the governing body are listed
httppremierhighschoolscomtexas-state-requi red-information
In accordance with the requirements of TEC sect12 136 an open-enrollment charter school shall post the salary of the schools superintendent or CEO on the schools internet website Provide the internet URL address where the superintendents salary is posted
httppremierhighschoolscomtexas-state-required-information
In accordance with Local Government Code sect140006 an open-enrollment charter school shall post continuously on the schools internet website the annual financials of the school Provide the internet URL address where the annual financial statements of the charter school are continuously posted
httppremierhighschoolscomtexas-state-required-information
Page9
Section IV
Organizational Charts
Submit as Attachment 1 the organizational chart for the charter school that specifies the administrative positions including the title and name of the individual currently in each position
Submit as Attachment 2 a chart that identifies all other entities under the direction of the charter holder This would include entities andor programs that the charter holder governsmanages in addition to the charter school
Page 10
I I
I I
I
middot~middot==middot==middotmiddotmiddotmiddot~~ Robert Davison liChief Operating O~cj
~1~ middotmiddotmiddotmiddotmiddotmiddot shyOr Mary Ann Duncan Gary Arnold Corey Thomas
VP-School VP - Human InformationI Operations I Resources Technology (IT)
--~~1~-- ---~~~
middotmiddotmiddotmiddotmiddotmiddot-middot -middot~ ----- shy
Kim OLeary PEIMS
ResponsiveEdPremier High Schools
Board of Directors
Chuck Cook Superintendent I
Chief Executive Officer
I Chris eaumaOn bull
General Counsel IVP - Business Oevelooment I
I ~--------1~ -middotmiddotmiddotmiddotmiddot ~ I
Jeffrie Evans Terri Baumann Brian Stevens carrie Alexander
Marketing amp Curriculum Facilities VP - Finance
Communications Development
I I
Regional Directors of Regional Directors of Operations Academics
campus Directors shyPremier High School shy
Premier High School Campus Staff
I
Or Alan Wimberley Chief Education
Architect
I I
Wesley Cockrum I=Software Kyle Queal
Development - Academics -----I_____
I
I
Responsive Education bullt--------------------------iI R~~~i~~=~~~~=~1Solutions
=~~~~~ I
1rmiddot~middot=middotmiddotmiddot=middot~-~--~middot-I Texas Education
Texas Education Indianapolis MayorsAustin Independent llAgency- Texas College Ohio Council ofd~~Amiddotdcp_p1 [~~
I
Agency- Premier High Office of EducationSchool District - 2 Preparatory Community Schools I State Board of Schools Charter Innovation - 1 School
Sites Academies Charter -5 Schoolsf roved I II Education -4 Charters District - 32 Sites ApprovedI District - 33 Sites Approved
l_ I n=li=middot
I ===-middotmiddot--middot
Section V
Admission Policy
Pie e be aware that any change to the terms ofan open-enrollment charter that relates to the following subjects
ade levels bullma middotmum enrollment
hie boundaries bullapprove ampus(es) bull approved s s bull relocation of bull charter holder n e bullcharter school (dis ct) name bull charter campus name bullcharter holder goveman bull articles of incorporation bull corporate bylaws bullmanagement company bull admission policy or bull the educational program of the sch
requires the commissioner ofeducations approva fan amendment (See sectI00 1033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admis middot n are accepted TEC sectI2117 requires that a charter school establish a reasonable application deadline for the 1bmission ofapplications for admission
Beginning of Period (MonthDay)
May4 2015
B If the school admits students by lottery when the number of admissions ap middotcations received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Not applicable
C If the school utilizes a lottery when oversubscribed are any categories ofapplicants exempted from th lottery
0Ycs
0No
0 Not applicable (because lotteries arc not utilized)
If Yes was indicated in C above state the categories ofapplicants that are exempted
Page 11
Section V
Admission Policy
Please be aware that any change to the terms of an open-enrollment charter that relates to the following subjects
bull grade levels bullmaximum enrollment bull geographic boundaries bullapproved campus(es) bull approved sites bull relocation of campus bull charter holdername bull charter school (district) name bull charter campus name bull charter holder governance bull articles of incorporation bullcorporate bylaws bull management company bull admission policy or bullthe educational program of the school
requires the commissioner of educations approval ofan amendment (See sect1001033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadline for the submission ofapplicationsfor admission
Beginning ofPeriod (MonthDay) End of Period (MonthDay)
--~~~-M-ay_4__2_01_s~~~--I l__~~~M_a_y_1_a_2_0_1s~~~---
B If the school admits students by lottery when the number of admissions applications received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Aname (or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) Is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order in which they were drawn Notification of admission will be made and failure of a parent to respond within 48 hours of notification will forfeit his or her position in the lottery
C lfthe school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
0Yes
ONo
0 Not applicable (because lotteries are not utilized)
IfYes was indicated in C above state the categories of annlicants that are exempted
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Page 11
Section V (Continued)
Admission Policy
e school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be con led
Approximate Date of Lottery (MonthDay) ceuroSS ~ ~l-0
NA coll11lGeurolc
0ull-1lG E If the school does not utilize ottery when oversubscribed bu lleuroJSeuro~euroll-l ctole positions in the order in which
applications were received befo the expiration of the applicatil seuroeuro l 11e a first-come first-served admission process) describe the manner in ich the school notifies the ct bull 11unity of the opportunity to apply for admission TEC sect12 117 requires a charter sc of that uses ajirst-comefirst-served admission process when ove1mbscribed to publish a notice in a newspaper ofge1 ral circulation not later than the seventh day before the application deadline
Advertisements are published in the local newspap notifying the community of the Open-Enrollment Period for the school at least seven days before the close of the Ope Enrollment Period
F lfthe school has a separate process for re-enrollment state e process and the timeline to be used
he Re-Enrollment Period will begin May 4 2015 and end May 14 2 15 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 15 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the ignated window as listed above Students who could continue at their current campus but wish to transfer to a different mier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and o in a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application dea ine has passed
If an Application is received from an eligible applicant after the close of the open-enrollment p iod the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely ap ied
H Describe the infom1ation that an applicant must provide in order to be considered for admission Appi ants may not be required to provide copies of transcripts or other academic records until after they are offered od1 middotsion and are enrolling Furthermore a student may not be precluded ji-om enrolling due to the charter schools fail e to receive biformation required for enrollment ji-om the students parent or guardian or previous school See TEC sect2 002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date ofLottery (MonthDay)
0520 APPROVED DURING CONTINGENCY PROCESS
E If the school does not utilize a lottery when oversubscribed but rather fills the available positions in the order in which applications were received before the expiration ofthe application deadline (ie a first-come first-served admission process) describe the manner in which the school notifies the community of the opportunity to apply for admission TEC sect12117 requires a charter school that uses a first-come first-served admission process when oversubscribed to publish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
NIA
F If the school has a separate process for re-enrollment state the process and the timeline to be used
lfhe Re-Enrollment Period will begin May 4 2015 and end May 14 2015 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 2015 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the designated window as listed above Students who could continue at their current campus but wish to transfer to a different Premier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and obtain a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application deadline has passed
If an Application Is received from an eligible applicant after the close of the open-enrollment period the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
H Describe the information that an applicant must provide in order to be considered for admission Applicants may not be required to provide copies of transcripts or other academic records until after they are offered admission and are enrolling Furthermore a student may not be precluded from enrolling due to the charter schools failure to receive information required for enrollment from the students parent or guardian or previous school See TEC sect25002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
I The charter holder certifies that the non-discrimination statement required by TEC sectI2 I I I (a)(5) is printed in the schools admission policy TEC sect121 I I (a)(5) requires that a charter schools admission policy include a statement that the school will not discriminate in admissions based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend
0Ycs
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories ofa criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 3 7 Subchapter A as authorized by TEC sectI21 II (a)(5)(B)
0 Yes (The school excludes such students or reserves the right to exclude such students from admissions)
0 No (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bullA current copy of the admission policy that incorporates the information provided in the above answers to questions
A through H and any other relevant information (Attachment 3)
bull A blank copy of the current admission application ie the information requested when the student first seeks
admission (Attachment 4) and
bullA blank copy of the current enrollment form(s) ie the information required once an applicant has been offered
admission and is registering for enrollment (Attachment 5)
Page 13
I I
i
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Explanation of Renewal Process
19 Texas Administrative Code (TAC) sectI 00 103J contains additional information about charter renewal
The renewal process is separate from the charter amendment process Significant changes from the original charter should not be made in the renewal application unless a charter amendment has been previously approved
As authorized in Texas Education Code (TEC) sect121141 the commissioners procedures for renewal must include three distinct processes expedited renewal discretionary renewal and expiration
Definitions of the three renewal processes
Expedited (30 days) If in the preceding 3 years bull Highest or second highest academic performance rating bull Satisfactory or higher financial rating and bull No campus has been assigned the lowest rating or no campus has been closed for low ratings
Discretionary (90 days) Consideration among others of bullAcademic Performance 2009-2010 2010-2011 2012-2013 2013-2014 bull Financial Ratings 2009-2010 20I0-2011 2011-2012 2012-2013 2013-2014 bullPerformance Framework (TEC sect121181)
Expiration (30 day notification) If for any 3 of the 5 preceding school years bull Lowest academic performance rating bull Lower than satisfactory financial rating bull The charter was assigned any combination of ratings or bull A campus has been assigned the lowest performance rating for the 3 preceding school years and has not been closed
The due date for charters to submit the completed renewal application to the Texas Education Agency (TEA) is Wednesday January 7 2015
You may request an informal review of the findings and actions described in this letter by sending a written request to
Brandon Spenrath Program Specialist Charter School Administration Texas Education Agency 170 I North Congress Ave Austin Texas 7870 I Fax (512) 936-9281 brand on spen rat h(iitea state tx us
The request must be received no later than Wednesday December 17 2014 Your request must identify what changes you are requesting the reasons for your request and documentation to support your request If we do not receive your request before the deadline final action will be taken without further review
Please see 19 TAC Chapter 157 subchapter EE Division I for addition information about the informal review process
Pagc4
Application Instructions
The renewal application contains ten sections to be completed electronically printed into hardcopy form for required signatures and dates and submitted on or before the due date to the Division ofCharter School Administration
1 Deadline The completed application must be returned by mail to the Division ofCharter School Administration by Wednesday January 7 2015
2 Typing Requirement All of the responses to the application sections with the exception ofsignatures and dates of signatures must be typed
3 Printing Requirement The application must be printed on one-sided 8 I 2 x 11 white paper
4 Signature Requirement Where signatures and dates ofsignatures are required they must be in blue ink
5 Submission of Original Document and One Copy The completed and unbound (rubber bands or clips are acceptable) original renewal application including fillable forms and attachments and one additional copy must be submitted as follows
Texas Education Agency Division ofCharter School Administration
170 I North Congress A venue Austin Texas 7870 I
Page 5
Selected Definitions
Please review TEC sect12 I OJ 2 and 19 TAC sect1001001 for definitions of terms which are available at the education laws and mies page Listed below are selected terms and definitions
bull Charter holder - the entity to which a charter is granted under TEC Chapter 12
bull Charter school - a Texas public school operated by a charter holder under an open-enrollment charter granted by the commissioner n pursuant to TEC sect12 J01
Governing body ofa charter holder - the board of directors board of tmstees or other governing body of a charter holder
bull Governing body ofa charter school - the board of directors board of trustees or other governing body of an open-enrollment charter school the term includes the governing body ofa charter holder ifthat body acts as the governing body of the open-enrollment charter school
bull Management company - a person or entity other than a charter holder that provides management services for an open-enrollment charter school
bull Officer ofa charter school - the principal director or other chief operating officer of an open-enrollment charter school an assistant principal or assistant director of an open-enrollment charter school or a person charged with managing the finances ofan open-enrollment charter school
bull Board chair or chaitperson - generally the board president or presiding officer of the governing board
Page 6
Section I
Coversheet
ATTACHMENT A OPEN-ENROLLMENT CHARTER CONTRACT RENEWAL
The enclosed document entitled OPEN-ENROLLMENT CHARTER CONTRACT RENEW AL will serve as the coversheet when the application is completed and submitted and includes current information in the Charter School Tracking System Verify the accuracy of the information on the coversheet and if updates to the information are needed create a separate sheet detailing your corrections and label the sheet Update to Data Provided by TEA and include it in the renewal packet immediately following the preprinted coversheet
Pagc7
Section II
Contact Information
The persons listed below will be contacted by agency staff ifthere are issues to be resolved in any ofthe renewal application sections Note that any contact information including email addresses provided with the renewal application will be public information
Superintendent Contact Information
Superintendents Name lcharles Cook
=============================================== Telephone Number 1(972) 316-3663
=============================================== Fax Number 1972-315-9506
=========================================~ E-mail Address lccookresponsiveedcom
Charter Holder Board Chair Contact Information
Board Chairs Name Marvin Reynolds
Telephone Number 1866-605-7772
Fax Number 1972-315-9506
E-mail Address leducatenationalhomeschoolcom
Application Preparers Contact Information El Same as Superintendent D Same as Board Chair
Contact Name lcharles Cook
Telephone Number 1(972) 316-3663
Fax Number 1972-315-9506
E-mail Address lccookresponsiveedcom
Charter School Website
Web address lhttppremierhighschoolscom
Page 8
Section III
Website Postings
In accordance with the requirements of TEC sect12 1211 an open-enrollment charter school shall list the names of the members of the governing body on the home page of the schools internet website Provide the internet URL address where the names of the members of the governing body are listed
httppremierhighschoolscomtexas-state-requi red-information
In accordance with the requirements of TEC sect12 136 an open-enrollment charter school shall post the salary of the schools superintendent or CEO on the schools internet website Provide the internet URL address where the superintendents salary is posted
httppremierhighschoolscomtexas-state-required-information
In accordance with Local Government Code sect140006 an open-enrollment charter school shall post continuously on the schools internet website the annual financials of the school Provide the internet URL address where the annual financial statements of the charter school are continuously posted
httppremierhighschoolscomtexas-state-required-information
Page9
Section IV
Organizational Charts
Submit as Attachment 1 the organizational chart for the charter school that specifies the administrative positions including the title and name of the individual currently in each position
Submit as Attachment 2 a chart that identifies all other entities under the direction of the charter holder This would include entities andor programs that the charter holder governsmanages in addition to the charter school
Page 10
I I
I I
I
middot~middot==middot==middotmiddotmiddotmiddot~~ Robert Davison liChief Operating O~cj
~1~ middotmiddotmiddotmiddotmiddotmiddot shyOr Mary Ann Duncan Gary Arnold Corey Thomas
VP-School VP - Human InformationI Operations I Resources Technology (IT)
--~~1~-- ---~~~
middotmiddotmiddotmiddotmiddotmiddot-middot -middot~ ----- shy
Kim OLeary PEIMS
ResponsiveEdPremier High Schools
Board of Directors
Chuck Cook Superintendent I
Chief Executive Officer
I Chris eaumaOn bull
General Counsel IVP - Business Oevelooment I
I ~--------1~ -middotmiddotmiddotmiddotmiddot ~ I
Jeffrie Evans Terri Baumann Brian Stevens carrie Alexander
Marketing amp Curriculum Facilities VP - Finance
Communications Development
I I
Regional Directors of Regional Directors of Operations Academics
campus Directors shyPremier High School shy
Premier High School Campus Staff
I
Or Alan Wimberley Chief Education
Architect
I I
Wesley Cockrum I=Software Kyle Queal
Development - Academics -----I_____
I
I
Responsive Education bullt--------------------------iI R~~~i~~=~~~~=~1Solutions
=~~~~~ I
1rmiddot~middot=middotmiddotmiddot=middot~-~--~middot-I Texas Education
Texas Education Indianapolis MayorsAustin Independent llAgency- Texas College Ohio Council ofd~~Amiddotdcp_p1 [~~
I
Agency- Premier High Office of EducationSchool District - 2 Preparatory Community Schools I State Board of Schools Charter Innovation - 1 School
Sites Academies Charter -5 Schoolsf roved I II Education -4 Charters District - 32 Sites ApprovedI District - 33 Sites Approved
l_ I n=li=middot
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Section V
Admission Policy
Pie e be aware that any change to the terms ofan open-enrollment charter that relates to the following subjects
ade levels bullma middotmum enrollment
hie boundaries bullapprove ampus(es) bull approved s s bull relocation of bull charter holder n e bullcharter school (dis ct) name bull charter campus name bullcharter holder goveman bull articles of incorporation bull corporate bylaws bullmanagement company bull admission policy or bull the educational program of the sch
requires the commissioner ofeducations approva fan amendment (See sectI00 1033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admis middot n are accepted TEC sectI2117 requires that a charter school establish a reasonable application deadline for the 1bmission ofapplications for admission
Beginning of Period (MonthDay)
May4 2015
B If the school admits students by lottery when the number of admissions ap middotcations received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Not applicable
C If the school utilizes a lottery when oversubscribed are any categories ofapplicants exempted from th lottery
0Ycs
0No
0 Not applicable (because lotteries arc not utilized)
If Yes was indicated in C above state the categories ofapplicants that are exempted
Page 11
Section V
Admission Policy
Please be aware that any change to the terms of an open-enrollment charter that relates to the following subjects
bull grade levels bullmaximum enrollment bull geographic boundaries bullapproved campus(es) bull approved sites bull relocation of campus bull charter holdername bull charter school (district) name bull charter campus name bull charter holder governance bull articles of incorporation bullcorporate bylaws bull management company bull admission policy or bullthe educational program of the school
requires the commissioner of educations approval ofan amendment (See sect1001033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadline for the submission ofapplicationsfor admission
Beginning ofPeriod (MonthDay) End of Period (MonthDay)
--~~~-M-ay_4__2_01_s~~~--I l__~~~M_a_y_1_a_2_0_1s~~~---
B If the school admits students by lottery when the number of admissions applications received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Aname (or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) Is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order in which they were drawn Notification of admission will be made and failure of a parent to respond within 48 hours of notification will forfeit his or her position in the lottery
C lfthe school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
0Yes
ONo
0 Not applicable (because lotteries are not utilized)
IfYes was indicated in C above state the categories of annlicants that are exempted
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Page 11
Section V (Continued)
Admission Policy
e school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be con led
Approximate Date of Lottery (MonthDay) ceuroSS ~ ~l-0
NA coll11lGeurolc
0ull-1lG E If the school does not utilize ottery when oversubscribed bu lleuroJSeuro~euroll-l ctole positions in the order in which
applications were received befo the expiration of the applicatil seuroeuro l 11e a first-come first-served admission process) describe the manner in ich the school notifies the ct bull 11unity of the opportunity to apply for admission TEC sect12 117 requires a charter sc of that uses ajirst-comefirst-served admission process when ove1mbscribed to publish a notice in a newspaper ofge1 ral circulation not later than the seventh day before the application deadline
Advertisements are published in the local newspap notifying the community of the Open-Enrollment Period for the school at least seven days before the close of the Ope Enrollment Period
F lfthe school has a separate process for re-enrollment state e process and the timeline to be used
he Re-Enrollment Period will begin May 4 2015 and end May 14 2 15 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 15 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the ignated window as listed above Students who could continue at their current campus but wish to transfer to a different mier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and o in a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application dea ine has passed
If an Application is received from an eligible applicant after the close of the open-enrollment p iod the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely ap ied
H Describe the infom1ation that an applicant must provide in order to be considered for admission Appi ants may not be required to provide copies of transcripts or other academic records until after they are offered od1 middotsion and are enrolling Furthermore a student may not be precluded ji-om enrolling due to the charter schools fail e to receive biformation required for enrollment ji-om the students parent or guardian or previous school See TEC sect2 002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date ofLottery (MonthDay)
0520 APPROVED DURING CONTINGENCY PROCESS
E If the school does not utilize a lottery when oversubscribed but rather fills the available positions in the order in which applications were received before the expiration ofthe application deadline (ie a first-come first-served admission process) describe the manner in which the school notifies the community of the opportunity to apply for admission TEC sect12117 requires a charter school that uses a first-come first-served admission process when oversubscribed to publish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
NIA
F If the school has a separate process for re-enrollment state the process and the timeline to be used
lfhe Re-Enrollment Period will begin May 4 2015 and end May 14 2015 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 2015 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the designated window as listed above Students who could continue at their current campus but wish to transfer to a different Premier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and obtain a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application deadline has passed
If an Application Is received from an eligible applicant after the close of the open-enrollment period the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
H Describe the information that an applicant must provide in order to be considered for admission Applicants may not be required to provide copies of transcripts or other academic records until after they are offered admission and are enrolling Furthermore a student may not be precluded from enrolling due to the charter schools failure to receive information required for enrollment from the students parent or guardian or previous school See TEC sect25002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
I The charter holder certifies that the non-discrimination statement required by TEC sectI2 I I I (a)(5) is printed in the schools admission policy TEC sect121 I I (a)(5) requires that a charter schools admission policy include a statement that the school will not discriminate in admissions based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend
0Ycs
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories ofa criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 3 7 Subchapter A as authorized by TEC sectI21 II (a)(5)(B)
0 Yes (The school excludes such students or reserves the right to exclude such students from admissions)
0 No (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bullA current copy of the admission policy that incorporates the information provided in the above answers to questions
A through H and any other relevant information (Attachment 3)
bull A blank copy of the current admission application ie the information requested when the student first seeks
admission (Attachment 4) and
bullA blank copy of the current enrollment form(s) ie the information required once an applicant has been offered
admission and is registering for enrollment (Attachment 5)
Page 13
I I
i
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Application Instructions
The renewal application contains ten sections to be completed electronically printed into hardcopy form for required signatures and dates and submitted on or before the due date to the Division ofCharter School Administration
1 Deadline The completed application must be returned by mail to the Division ofCharter School Administration by Wednesday January 7 2015
2 Typing Requirement All of the responses to the application sections with the exception ofsignatures and dates of signatures must be typed
3 Printing Requirement The application must be printed on one-sided 8 I 2 x 11 white paper
4 Signature Requirement Where signatures and dates ofsignatures are required they must be in blue ink
5 Submission of Original Document and One Copy The completed and unbound (rubber bands or clips are acceptable) original renewal application including fillable forms and attachments and one additional copy must be submitted as follows
Texas Education Agency Division ofCharter School Administration
170 I North Congress A venue Austin Texas 7870 I
Page 5
Selected Definitions
Please review TEC sect12 I OJ 2 and 19 TAC sect1001001 for definitions of terms which are available at the education laws and mies page Listed below are selected terms and definitions
bull Charter holder - the entity to which a charter is granted under TEC Chapter 12
bull Charter school - a Texas public school operated by a charter holder under an open-enrollment charter granted by the commissioner n pursuant to TEC sect12 J01
Governing body ofa charter holder - the board of directors board of tmstees or other governing body of a charter holder
bull Governing body ofa charter school - the board of directors board of trustees or other governing body of an open-enrollment charter school the term includes the governing body ofa charter holder ifthat body acts as the governing body of the open-enrollment charter school
bull Management company - a person or entity other than a charter holder that provides management services for an open-enrollment charter school
bull Officer ofa charter school - the principal director or other chief operating officer of an open-enrollment charter school an assistant principal or assistant director of an open-enrollment charter school or a person charged with managing the finances ofan open-enrollment charter school
bull Board chair or chaitperson - generally the board president or presiding officer of the governing board
Page 6
Section I
Coversheet
ATTACHMENT A OPEN-ENROLLMENT CHARTER CONTRACT RENEWAL
The enclosed document entitled OPEN-ENROLLMENT CHARTER CONTRACT RENEW AL will serve as the coversheet when the application is completed and submitted and includes current information in the Charter School Tracking System Verify the accuracy of the information on the coversheet and if updates to the information are needed create a separate sheet detailing your corrections and label the sheet Update to Data Provided by TEA and include it in the renewal packet immediately following the preprinted coversheet
Pagc7
Section II
Contact Information
The persons listed below will be contacted by agency staff ifthere are issues to be resolved in any ofthe renewal application sections Note that any contact information including email addresses provided with the renewal application will be public information
Superintendent Contact Information
Superintendents Name lcharles Cook
=============================================== Telephone Number 1(972) 316-3663
=============================================== Fax Number 1972-315-9506
=========================================~ E-mail Address lccookresponsiveedcom
Charter Holder Board Chair Contact Information
Board Chairs Name Marvin Reynolds
Telephone Number 1866-605-7772
Fax Number 1972-315-9506
E-mail Address leducatenationalhomeschoolcom
Application Preparers Contact Information El Same as Superintendent D Same as Board Chair
Contact Name lcharles Cook
Telephone Number 1(972) 316-3663
Fax Number 1972-315-9506
E-mail Address lccookresponsiveedcom
Charter School Website
Web address lhttppremierhighschoolscom
Page 8
Section III
Website Postings
In accordance with the requirements of TEC sect12 1211 an open-enrollment charter school shall list the names of the members of the governing body on the home page of the schools internet website Provide the internet URL address where the names of the members of the governing body are listed
httppremierhighschoolscomtexas-state-requi red-information
In accordance with the requirements of TEC sect12 136 an open-enrollment charter school shall post the salary of the schools superintendent or CEO on the schools internet website Provide the internet URL address where the superintendents salary is posted
httppremierhighschoolscomtexas-state-required-information
In accordance with Local Government Code sect140006 an open-enrollment charter school shall post continuously on the schools internet website the annual financials of the school Provide the internet URL address where the annual financial statements of the charter school are continuously posted
httppremierhighschoolscomtexas-state-required-information
Page9
Section IV
Organizational Charts
Submit as Attachment 1 the organizational chart for the charter school that specifies the administrative positions including the title and name of the individual currently in each position
Submit as Attachment 2 a chart that identifies all other entities under the direction of the charter holder This would include entities andor programs that the charter holder governsmanages in addition to the charter school
Page 10
I I
I I
I
middot~middot==middot==middotmiddotmiddotmiddot~~ Robert Davison liChief Operating O~cj
~1~ middotmiddotmiddotmiddotmiddotmiddot shyOr Mary Ann Duncan Gary Arnold Corey Thomas
VP-School VP - Human InformationI Operations I Resources Technology (IT)
--~~1~-- ---~~~
middotmiddotmiddotmiddotmiddotmiddot-middot -middot~ ----- shy
Kim OLeary PEIMS
ResponsiveEdPremier High Schools
Board of Directors
Chuck Cook Superintendent I
Chief Executive Officer
I Chris eaumaOn bull
General Counsel IVP - Business Oevelooment I
I ~--------1~ -middotmiddotmiddotmiddotmiddot ~ I
Jeffrie Evans Terri Baumann Brian Stevens carrie Alexander
Marketing amp Curriculum Facilities VP - Finance
Communications Development
I I
Regional Directors of Regional Directors of Operations Academics
campus Directors shyPremier High School shy
Premier High School Campus Staff
I
Or Alan Wimberley Chief Education
Architect
I I
Wesley Cockrum I=Software Kyle Queal
Development - Academics -----I_____
I
I
Responsive Education bullt--------------------------iI R~~~i~~=~~~~=~1Solutions
=~~~~~ I
1rmiddot~middot=middotmiddotmiddot=middot~-~--~middot-I Texas Education
Texas Education Indianapolis MayorsAustin Independent llAgency- Texas College Ohio Council ofd~~Amiddotdcp_p1 [~~
I
Agency- Premier High Office of EducationSchool District - 2 Preparatory Community Schools I State Board of Schools Charter Innovation - 1 School
Sites Academies Charter -5 Schoolsf roved I II Education -4 Charters District - 32 Sites ApprovedI District - 33 Sites Approved
l_ I n=li=middot
I ===-middotmiddot--middot
Section V
Admission Policy
Pie e be aware that any change to the terms ofan open-enrollment charter that relates to the following subjects
ade levels bullma middotmum enrollment
hie boundaries bullapprove ampus(es) bull approved s s bull relocation of bull charter holder n e bullcharter school (dis ct) name bull charter campus name bullcharter holder goveman bull articles of incorporation bull corporate bylaws bullmanagement company bull admission policy or bull the educational program of the sch
requires the commissioner ofeducations approva fan amendment (See sectI00 1033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admis middot n are accepted TEC sectI2117 requires that a charter school establish a reasonable application deadline for the 1bmission ofapplications for admission
Beginning of Period (MonthDay)
May4 2015
B If the school admits students by lottery when the number of admissions ap middotcations received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Not applicable
C If the school utilizes a lottery when oversubscribed are any categories ofapplicants exempted from th lottery
0Ycs
0No
0 Not applicable (because lotteries arc not utilized)
If Yes was indicated in C above state the categories ofapplicants that are exempted
Page 11
Section V
Admission Policy
Please be aware that any change to the terms of an open-enrollment charter that relates to the following subjects
bull grade levels bullmaximum enrollment bull geographic boundaries bullapproved campus(es) bull approved sites bull relocation of campus bull charter holdername bull charter school (district) name bull charter campus name bull charter holder governance bull articles of incorporation bullcorporate bylaws bull management company bull admission policy or bullthe educational program of the school
requires the commissioner of educations approval ofan amendment (See sect1001033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadline for the submission ofapplicationsfor admission
Beginning ofPeriod (MonthDay) End of Period (MonthDay)
--~~~-M-ay_4__2_01_s~~~--I l__~~~M_a_y_1_a_2_0_1s~~~---
B If the school admits students by lottery when the number of admissions applications received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Aname (or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) Is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order in which they were drawn Notification of admission will be made and failure of a parent to respond within 48 hours of notification will forfeit his or her position in the lottery
C lfthe school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
0Yes
ONo
0 Not applicable (because lotteries are not utilized)
IfYes was indicated in C above state the categories of annlicants that are exempted
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Page 11
Section V (Continued)
Admission Policy
e school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be con led
Approximate Date of Lottery (MonthDay) ceuroSS ~ ~l-0
NA coll11lGeurolc
0ull-1lG E If the school does not utilize ottery when oversubscribed bu lleuroJSeuro~euroll-l ctole positions in the order in which
applications were received befo the expiration of the applicatil seuroeuro l 11e a first-come first-served admission process) describe the manner in ich the school notifies the ct bull 11unity of the opportunity to apply for admission TEC sect12 117 requires a charter sc of that uses ajirst-comefirst-served admission process when ove1mbscribed to publish a notice in a newspaper ofge1 ral circulation not later than the seventh day before the application deadline
Advertisements are published in the local newspap notifying the community of the Open-Enrollment Period for the school at least seven days before the close of the Ope Enrollment Period
F lfthe school has a separate process for re-enrollment state e process and the timeline to be used
he Re-Enrollment Period will begin May 4 2015 and end May 14 2 15 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 15 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the ignated window as listed above Students who could continue at their current campus but wish to transfer to a different mier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and o in a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application dea ine has passed
If an Application is received from an eligible applicant after the close of the open-enrollment p iod the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely ap ied
H Describe the infom1ation that an applicant must provide in order to be considered for admission Appi ants may not be required to provide copies of transcripts or other academic records until after they are offered od1 middotsion and are enrolling Furthermore a student may not be precluded ji-om enrolling due to the charter schools fail e to receive biformation required for enrollment ji-om the students parent or guardian or previous school See TEC sect2 002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date ofLottery (MonthDay)
0520 APPROVED DURING CONTINGENCY PROCESS
E If the school does not utilize a lottery when oversubscribed but rather fills the available positions in the order in which applications were received before the expiration ofthe application deadline (ie a first-come first-served admission process) describe the manner in which the school notifies the community of the opportunity to apply for admission TEC sect12117 requires a charter school that uses a first-come first-served admission process when oversubscribed to publish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
NIA
F If the school has a separate process for re-enrollment state the process and the timeline to be used
lfhe Re-Enrollment Period will begin May 4 2015 and end May 14 2015 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 2015 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the designated window as listed above Students who could continue at their current campus but wish to transfer to a different Premier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and obtain a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application deadline has passed
If an Application Is received from an eligible applicant after the close of the open-enrollment period the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
H Describe the information that an applicant must provide in order to be considered for admission Applicants may not be required to provide copies of transcripts or other academic records until after they are offered admission and are enrolling Furthermore a student may not be precluded from enrolling due to the charter schools failure to receive information required for enrollment from the students parent or guardian or previous school See TEC sect25002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
I The charter holder certifies that the non-discrimination statement required by TEC sectI2 I I I (a)(5) is printed in the schools admission policy TEC sect121 I I (a)(5) requires that a charter schools admission policy include a statement that the school will not discriminate in admissions based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend
0Ycs
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories ofa criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 3 7 Subchapter A as authorized by TEC sectI21 II (a)(5)(B)
0 Yes (The school excludes such students or reserves the right to exclude such students from admissions)
0 No (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bullA current copy of the admission policy that incorporates the information provided in the above answers to questions
A through H and any other relevant information (Attachment 3)
bull A blank copy of the current admission application ie the information requested when the student first seeks
admission (Attachment 4) and
bullA blank copy of the current enrollment form(s) ie the information required once an applicant has been offered
admission and is registering for enrollment (Attachment 5)
Page 13
I I
i
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Selected Definitions
Please review TEC sect12 I OJ 2 and 19 TAC sect1001001 for definitions of terms which are available at the education laws and mies page Listed below are selected terms and definitions
bull Charter holder - the entity to which a charter is granted under TEC Chapter 12
bull Charter school - a Texas public school operated by a charter holder under an open-enrollment charter granted by the commissioner n pursuant to TEC sect12 J01
Governing body ofa charter holder - the board of directors board of tmstees or other governing body of a charter holder
bull Governing body ofa charter school - the board of directors board of trustees or other governing body of an open-enrollment charter school the term includes the governing body ofa charter holder ifthat body acts as the governing body of the open-enrollment charter school
bull Management company - a person or entity other than a charter holder that provides management services for an open-enrollment charter school
bull Officer ofa charter school - the principal director or other chief operating officer of an open-enrollment charter school an assistant principal or assistant director of an open-enrollment charter school or a person charged with managing the finances ofan open-enrollment charter school
bull Board chair or chaitperson - generally the board president or presiding officer of the governing board
Page 6
Section I
Coversheet
ATTACHMENT A OPEN-ENROLLMENT CHARTER CONTRACT RENEWAL
The enclosed document entitled OPEN-ENROLLMENT CHARTER CONTRACT RENEW AL will serve as the coversheet when the application is completed and submitted and includes current information in the Charter School Tracking System Verify the accuracy of the information on the coversheet and if updates to the information are needed create a separate sheet detailing your corrections and label the sheet Update to Data Provided by TEA and include it in the renewal packet immediately following the preprinted coversheet
Pagc7
Section II
Contact Information
The persons listed below will be contacted by agency staff ifthere are issues to be resolved in any ofthe renewal application sections Note that any contact information including email addresses provided with the renewal application will be public information
Superintendent Contact Information
Superintendents Name lcharles Cook
=============================================== Telephone Number 1(972) 316-3663
=============================================== Fax Number 1972-315-9506
=========================================~ E-mail Address lccookresponsiveedcom
Charter Holder Board Chair Contact Information
Board Chairs Name Marvin Reynolds
Telephone Number 1866-605-7772
Fax Number 1972-315-9506
E-mail Address leducatenationalhomeschoolcom
Application Preparers Contact Information El Same as Superintendent D Same as Board Chair
Contact Name lcharles Cook
Telephone Number 1(972) 316-3663
Fax Number 1972-315-9506
E-mail Address lccookresponsiveedcom
Charter School Website
Web address lhttppremierhighschoolscom
Page 8
Section III
Website Postings
In accordance with the requirements of TEC sect12 1211 an open-enrollment charter school shall list the names of the members of the governing body on the home page of the schools internet website Provide the internet URL address where the names of the members of the governing body are listed
httppremierhighschoolscomtexas-state-requi red-information
In accordance with the requirements of TEC sect12 136 an open-enrollment charter school shall post the salary of the schools superintendent or CEO on the schools internet website Provide the internet URL address where the superintendents salary is posted
httppremierhighschoolscomtexas-state-required-information
In accordance with Local Government Code sect140006 an open-enrollment charter school shall post continuously on the schools internet website the annual financials of the school Provide the internet URL address where the annual financial statements of the charter school are continuously posted
httppremierhighschoolscomtexas-state-required-information
Page9
Section IV
Organizational Charts
Submit as Attachment 1 the organizational chart for the charter school that specifies the administrative positions including the title and name of the individual currently in each position
Submit as Attachment 2 a chart that identifies all other entities under the direction of the charter holder This would include entities andor programs that the charter holder governsmanages in addition to the charter school
Page 10
I I
I I
I
middot~middot==middot==middotmiddotmiddotmiddot~~ Robert Davison liChief Operating O~cj
~1~ middotmiddotmiddotmiddotmiddotmiddot shyOr Mary Ann Duncan Gary Arnold Corey Thomas
VP-School VP - Human InformationI Operations I Resources Technology (IT)
--~~1~-- ---~~~
middotmiddotmiddotmiddotmiddotmiddot-middot -middot~ ----- shy
Kim OLeary PEIMS
ResponsiveEdPremier High Schools
Board of Directors
Chuck Cook Superintendent I
Chief Executive Officer
I Chris eaumaOn bull
General Counsel IVP - Business Oevelooment I
I ~--------1~ -middotmiddotmiddotmiddotmiddot ~ I
Jeffrie Evans Terri Baumann Brian Stevens carrie Alexander
Marketing amp Curriculum Facilities VP - Finance
Communications Development
I I
Regional Directors of Regional Directors of Operations Academics
campus Directors shyPremier High School shy
Premier High School Campus Staff
I
Or Alan Wimberley Chief Education
Architect
I I
Wesley Cockrum I=Software Kyle Queal
Development - Academics -----I_____
I
I
Responsive Education bullt--------------------------iI R~~~i~~=~~~~=~1Solutions
=~~~~~ I
1rmiddot~middot=middotmiddotmiddot=middot~-~--~middot-I Texas Education
Texas Education Indianapolis MayorsAustin Independent llAgency- Texas College Ohio Council ofd~~Amiddotdcp_p1 [~~
I
Agency- Premier High Office of EducationSchool District - 2 Preparatory Community Schools I State Board of Schools Charter Innovation - 1 School
Sites Academies Charter -5 Schoolsf roved I II Education -4 Charters District - 32 Sites ApprovedI District - 33 Sites Approved
l_ I n=li=middot
I ===-middotmiddot--middot
Section V
Admission Policy
Pie e be aware that any change to the terms ofan open-enrollment charter that relates to the following subjects
ade levels bullma middotmum enrollment
hie boundaries bullapprove ampus(es) bull approved s s bull relocation of bull charter holder n e bullcharter school (dis ct) name bull charter campus name bullcharter holder goveman bull articles of incorporation bull corporate bylaws bullmanagement company bull admission policy or bull the educational program of the sch
requires the commissioner ofeducations approva fan amendment (See sectI00 1033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admis middot n are accepted TEC sectI2117 requires that a charter school establish a reasonable application deadline for the 1bmission ofapplications for admission
Beginning of Period (MonthDay)
May4 2015
B If the school admits students by lottery when the number of admissions ap middotcations received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Not applicable
C If the school utilizes a lottery when oversubscribed are any categories ofapplicants exempted from th lottery
0Ycs
0No
0 Not applicable (because lotteries arc not utilized)
If Yes was indicated in C above state the categories ofapplicants that are exempted
Page 11
Section V
Admission Policy
Please be aware that any change to the terms of an open-enrollment charter that relates to the following subjects
bull grade levels bullmaximum enrollment bull geographic boundaries bullapproved campus(es) bull approved sites bull relocation of campus bull charter holdername bull charter school (district) name bull charter campus name bull charter holder governance bull articles of incorporation bullcorporate bylaws bull management company bull admission policy or bullthe educational program of the school
requires the commissioner of educations approval ofan amendment (See sect1001033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadline for the submission ofapplicationsfor admission
Beginning ofPeriod (MonthDay) End of Period (MonthDay)
--~~~-M-ay_4__2_01_s~~~--I l__~~~M_a_y_1_a_2_0_1s~~~---
B If the school admits students by lottery when the number of admissions applications received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Aname (or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) Is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order in which they were drawn Notification of admission will be made and failure of a parent to respond within 48 hours of notification will forfeit his or her position in the lottery
C lfthe school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
0Yes
ONo
0 Not applicable (because lotteries are not utilized)
IfYes was indicated in C above state the categories of annlicants that are exempted
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Page 11
Section V (Continued)
Admission Policy
e school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be con led
Approximate Date of Lottery (MonthDay) ceuroSS ~ ~l-0
NA coll11lGeurolc
0ull-1lG E If the school does not utilize ottery when oversubscribed bu lleuroJSeuro~euroll-l ctole positions in the order in which
applications were received befo the expiration of the applicatil seuroeuro l 11e a first-come first-served admission process) describe the manner in ich the school notifies the ct bull 11unity of the opportunity to apply for admission TEC sect12 117 requires a charter sc of that uses ajirst-comefirst-served admission process when ove1mbscribed to publish a notice in a newspaper ofge1 ral circulation not later than the seventh day before the application deadline
Advertisements are published in the local newspap notifying the community of the Open-Enrollment Period for the school at least seven days before the close of the Ope Enrollment Period
F lfthe school has a separate process for re-enrollment state e process and the timeline to be used
he Re-Enrollment Period will begin May 4 2015 and end May 14 2 15 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 15 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the ignated window as listed above Students who could continue at their current campus but wish to transfer to a different mier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and o in a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application dea ine has passed
If an Application is received from an eligible applicant after the close of the open-enrollment p iod the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely ap ied
H Describe the infom1ation that an applicant must provide in order to be considered for admission Appi ants may not be required to provide copies of transcripts or other academic records until after they are offered od1 middotsion and are enrolling Furthermore a student may not be precluded ji-om enrolling due to the charter schools fail e to receive biformation required for enrollment ji-om the students parent or guardian or previous school See TEC sect2 002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date ofLottery (MonthDay)
0520 APPROVED DURING CONTINGENCY PROCESS
E If the school does not utilize a lottery when oversubscribed but rather fills the available positions in the order in which applications were received before the expiration ofthe application deadline (ie a first-come first-served admission process) describe the manner in which the school notifies the community of the opportunity to apply for admission TEC sect12117 requires a charter school that uses a first-come first-served admission process when oversubscribed to publish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
NIA
F If the school has a separate process for re-enrollment state the process and the timeline to be used
lfhe Re-Enrollment Period will begin May 4 2015 and end May 14 2015 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 2015 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the designated window as listed above Students who could continue at their current campus but wish to transfer to a different Premier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and obtain a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application deadline has passed
If an Application Is received from an eligible applicant after the close of the open-enrollment period the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
H Describe the information that an applicant must provide in order to be considered for admission Applicants may not be required to provide copies of transcripts or other academic records until after they are offered admission and are enrolling Furthermore a student may not be precluded from enrolling due to the charter schools failure to receive information required for enrollment from the students parent or guardian or previous school See TEC sect25002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
I The charter holder certifies that the non-discrimination statement required by TEC sectI2 I I I (a)(5) is printed in the schools admission policy TEC sect121 I I (a)(5) requires that a charter schools admission policy include a statement that the school will not discriminate in admissions based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend
0Ycs
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories ofa criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 3 7 Subchapter A as authorized by TEC sectI21 II (a)(5)(B)
0 Yes (The school excludes such students or reserves the right to exclude such students from admissions)
0 No (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bullA current copy of the admission policy that incorporates the information provided in the above answers to questions
A through H and any other relevant information (Attachment 3)
bull A blank copy of the current admission application ie the information requested when the student first seeks
admission (Attachment 4) and
bullA blank copy of the current enrollment form(s) ie the information required once an applicant has been offered
admission and is registering for enrollment (Attachment 5)
Page 13
I I
i
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Section I
Coversheet
ATTACHMENT A OPEN-ENROLLMENT CHARTER CONTRACT RENEWAL
The enclosed document entitled OPEN-ENROLLMENT CHARTER CONTRACT RENEW AL will serve as the coversheet when the application is completed and submitted and includes current information in the Charter School Tracking System Verify the accuracy of the information on the coversheet and if updates to the information are needed create a separate sheet detailing your corrections and label the sheet Update to Data Provided by TEA and include it in the renewal packet immediately following the preprinted coversheet
Pagc7
Section II
Contact Information
The persons listed below will be contacted by agency staff ifthere are issues to be resolved in any ofthe renewal application sections Note that any contact information including email addresses provided with the renewal application will be public information
Superintendent Contact Information
Superintendents Name lcharles Cook
=============================================== Telephone Number 1(972) 316-3663
=============================================== Fax Number 1972-315-9506
=========================================~ E-mail Address lccookresponsiveedcom
Charter Holder Board Chair Contact Information
Board Chairs Name Marvin Reynolds
Telephone Number 1866-605-7772
Fax Number 1972-315-9506
E-mail Address leducatenationalhomeschoolcom
Application Preparers Contact Information El Same as Superintendent D Same as Board Chair
Contact Name lcharles Cook
Telephone Number 1(972) 316-3663
Fax Number 1972-315-9506
E-mail Address lccookresponsiveedcom
Charter School Website
Web address lhttppremierhighschoolscom
Page 8
Section III
Website Postings
In accordance with the requirements of TEC sect12 1211 an open-enrollment charter school shall list the names of the members of the governing body on the home page of the schools internet website Provide the internet URL address where the names of the members of the governing body are listed
httppremierhighschoolscomtexas-state-requi red-information
In accordance with the requirements of TEC sect12 136 an open-enrollment charter school shall post the salary of the schools superintendent or CEO on the schools internet website Provide the internet URL address where the superintendents salary is posted
httppremierhighschoolscomtexas-state-required-information
In accordance with Local Government Code sect140006 an open-enrollment charter school shall post continuously on the schools internet website the annual financials of the school Provide the internet URL address where the annual financial statements of the charter school are continuously posted
httppremierhighschoolscomtexas-state-required-information
Page9
Section IV
Organizational Charts
Submit as Attachment 1 the organizational chart for the charter school that specifies the administrative positions including the title and name of the individual currently in each position
Submit as Attachment 2 a chart that identifies all other entities under the direction of the charter holder This would include entities andor programs that the charter holder governsmanages in addition to the charter school
Page 10
I I
I I
I
middot~middot==middot==middotmiddotmiddotmiddot~~ Robert Davison liChief Operating O~cj
~1~ middotmiddotmiddotmiddotmiddotmiddot shyOr Mary Ann Duncan Gary Arnold Corey Thomas
VP-School VP - Human InformationI Operations I Resources Technology (IT)
--~~1~-- ---~~~
middotmiddotmiddotmiddotmiddotmiddot-middot -middot~ ----- shy
Kim OLeary PEIMS
ResponsiveEdPremier High Schools
Board of Directors
Chuck Cook Superintendent I
Chief Executive Officer
I Chris eaumaOn bull
General Counsel IVP - Business Oevelooment I
I ~--------1~ -middotmiddotmiddotmiddotmiddot ~ I
Jeffrie Evans Terri Baumann Brian Stevens carrie Alexander
Marketing amp Curriculum Facilities VP - Finance
Communications Development
I I
Regional Directors of Regional Directors of Operations Academics
campus Directors shyPremier High School shy
Premier High School Campus Staff
I
Or Alan Wimberley Chief Education
Architect
I I
Wesley Cockrum I=Software Kyle Queal
Development - Academics -----I_____
I
I
Responsive Education bullt--------------------------iI R~~~i~~=~~~~=~1Solutions
=~~~~~ I
1rmiddot~middot=middotmiddotmiddot=middot~-~--~middot-I Texas Education
Texas Education Indianapolis MayorsAustin Independent llAgency- Texas College Ohio Council ofd~~Amiddotdcp_p1 [~~
I
Agency- Premier High Office of EducationSchool District - 2 Preparatory Community Schools I State Board of Schools Charter Innovation - 1 School
Sites Academies Charter -5 Schoolsf roved I II Education -4 Charters District - 32 Sites ApprovedI District - 33 Sites Approved
l_ I n=li=middot
I ===-middotmiddot--middot
Section V
Admission Policy
Pie e be aware that any change to the terms ofan open-enrollment charter that relates to the following subjects
ade levels bullma middotmum enrollment
hie boundaries bullapprove ampus(es) bull approved s s bull relocation of bull charter holder n e bullcharter school (dis ct) name bull charter campus name bullcharter holder goveman bull articles of incorporation bull corporate bylaws bullmanagement company bull admission policy or bull the educational program of the sch
requires the commissioner ofeducations approva fan amendment (See sectI00 1033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admis middot n are accepted TEC sectI2117 requires that a charter school establish a reasonable application deadline for the 1bmission ofapplications for admission
Beginning of Period (MonthDay)
May4 2015
B If the school admits students by lottery when the number of admissions ap middotcations received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Not applicable
C If the school utilizes a lottery when oversubscribed are any categories ofapplicants exempted from th lottery
0Ycs
0No
0 Not applicable (because lotteries arc not utilized)
If Yes was indicated in C above state the categories ofapplicants that are exempted
Page 11
Section V
Admission Policy
Please be aware that any change to the terms of an open-enrollment charter that relates to the following subjects
bull grade levels bullmaximum enrollment bull geographic boundaries bullapproved campus(es) bull approved sites bull relocation of campus bull charter holdername bull charter school (district) name bull charter campus name bull charter holder governance bull articles of incorporation bullcorporate bylaws bull management company bull admission policy or bullthe educational program of the school
requires the commissioner of educations approval ofan amendment (See sect1001033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadline for the submission ofapplicationsfor admission
Beginning ofPeriod (MonthDay) End of Period (MonthDay)
--~~~-M-ay_4__2_01_s~~~--I l__~~~M_a_y_1_a_2_0_1s~~~---
B If the school admits students by lottery when the number of admissions applications received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Aname (or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) Is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order in which they were drawn Notification of admission will be made and failure of a parent to respond within 48 hours of notification will forfeit his or her position in the lottery
C lfthe school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
0Yes
ONo
0 Not applicable (because lotteries are not utilized)
IfYes was indicated in C above state the categories of annlicants that are exempted
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Page 11
Section V (Continued)
Admission Policy
e school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be con led
Approximate Date of Lottery (MonthDay) ceuroSS ~ ~l-0
NA coll11lGeurolc
0ull-1lG E If the school does not utilize ottery when oversubscribed bu lleuroJSeuro~euroll-l ctole positions in the order in which
applications were received befo the expiration of the applicatil seuroeuro l 11e a first-come first-served admission process) describe the manner in ich the school notifies the ct bull 11unity of the opportunity to apply for admission TEC sect12 117 requires a charter sc of that uses ajirst-comefirst-served admission process when ove1mbscribed to publish a notice in a newspaper ofge1 ral circulation not later than the seventh day before the application deadline
Advertisements are published in the local newspap notifying the community of the Open-Enrollment Period for the school at least seven days before the close of the Ope Enrollment Period
F lfthe school has a separate process for re-enrollment state e process and the timeline to be used
he Re-Enrollment Period will begin May 4 2015 and end May 14 2 15 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 15 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the ignated window as listed above Students who could continue at their current campus but wish to transfer to a different mier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and o in a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application dea ine has passed
If an Application is received from an eligible applicant after the close of the open-enrollment p iod the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely ap ied
H Describe the infom1ation that an applicant must provide in order to be considered for admission Appi ants may not be required to provide copies of transcripts or other academic records until after they are offered od1 middotsion and are enrolling Furthermore a student may not be precluded ji-om enrolling due to the charter schools fail e to receive biformation required for enrollment ji-om the students parent or guardian or previous school See TEC sect2 002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date ofLottery (MonthDay)
0520 APPROVED DURING CONTINGENCY PROCESS
E If the school does not utilize a lottery when oversubscribed but rather fills the available positions in the order in which applications were received before the expiration ofthe application deadline (ie a first-come first-served admission process) describe the manner in which the school notifies the community of the opportunity to apply for admission TEC sect12117 requires a charter school that uses a first-come first-served admission process when oversubscribed to publish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
NIA
F If the school has a separate process for re-enrollment state the process and the timeline to be used
lfhe Re-Enrollment Period will begin May 4 2015 and end May 14 2015 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 2015 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the designated window as listed above Students who could continue at their current campus but wish to transfer to a different Premier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and obtain a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application deadline has passed
If an Application Is received from an eligible applicant after the close of the open-enrollment period the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
H Describe the information that an applicant must provide in order to be considered for admission Applicants may not be required to provide copies of transcripts or other academic records until after they are offered admission and are enrolling Furthermore a student may not be precluded from enrolling due to the charter schools failure to receive information required for enrollment from the students parent or guardian or previous school See TEC sect25002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
I The charter holder certifies that the non-discrimination statement required by TEC sectI2 I I I (a)(5) is printed in the schools admission policy TEC sect121 I I (a)(5) requires that a charter schools admission policy include a statement that the school will not discriminate in admissions based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend
0Ycs
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories ofa criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 3 7 Subchapter A as authorized by TEC sectI21 II (a)(5)(B)
0 Yes (The school excludes such students or reserves the right to exclude such students from admissions)
0 No (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bullA current copy of the admission policy that incorporates the information provided in the above answers to questions
A through H and any other relevant information (Attachment 3)
bull A blank copy of the current admission application ie the information requested when the student first seeks
admission (Attachment 4) and
bullA blank copy of the current enrollment form(s) ie the information required once an applicant has been offered
admission and is registering for enrollment (Attachment 5)
Page 13
I I
i
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Section II
Contact Information
The persons listed below will be contacted by agency staff ifthere are issues to be resolved in any ofthe renewal application sections Note that any contact information including email addresses provided with the renewal application will be public information
Superintendent Contact Information
Superintendents Name lcharles Cook
=============================================== Telephone Number 1(972) 316-3663
=============================================== Fax Number 1972-315-9506
=========================================~ E-mail Address lccookresponsiveedcom
Charter Holder Board Chair Contact Information
Board Chairs Name Marvin Reynolds
Telephone Number 1866-605-7772
Fax Number 1972-315-9506
E-mail Address leducatenationalhomeschoolcom
Application Preparers Contact Information El Same as Superintendent D Same as Board Chair
Contact Name lcharles Cook
Telephone Number 1(972) 316-3663
Fax Number 1972-315-9506
E-mail Address lccookresponsiveedcom
Charter School Website
Web address lhttppremierhighschoolscom
Page 8
Section III
Website Postings
In accordance with the requirements of TEC sect12 1211 an open-enrollment charter school shall list the names of the members of the governing body on the home page of the schools internet website Provide the internet URL address where the names of the members of the governing body are listed
httppremierhighschoolscomtexas-state-requi red-information
In accordance with the requirements of TEC sect12 136 an open-enrollment charter school shall post the salary of the schools superintendent or CEO on the schools internet website Provide the internet URL address where the superintendents salary is posted
httppremierhighschoolscomtexas-state-required-information
In accordance with Local Government Code sect140006 an open-enrollment charter school shall post continuously on the schools internet website the annual financials of the school Provide the internet URL address where the annual financial statements of the charter school are continuously posted
httppremierhighschoolscomtexas-state-required-information
Page9
Section IV
Organizational Charts
Submit as Attachment 1 the organizational chart for the charter school that specifies the administrative positions including the title and name of the individual currently in each position
Submit as Attachment 2 a chart that identifies all other entities under the direction of the charter holder This would include entities andor programs that the charter holder governsmanages in addition to the charter school
Page 10
I I
I I
I
middot~middot==middot==middotmiddotmiddotmiddot~~ Robert Davison liChief Operating O~cj
~1~ middotmiddotmiddotmiddotmiddotmiddot shyOr Mary Ann Duncan Gary Arnold Corey Thomas
VP-School VP - Human InformationI Operations I Resources Technology (IT)
--~~1~-- ---~~~
middotmiddotmiddotmiddotmiddotmiddot-middot -middot~ ----- shy
Kim OLeary PEIMS
ResponsiveEdPremier High Schools
Board of Directors
Chuck Cook Superintendent I
Chief Executive Officer
I Chris eaumaOn bull
General Counsel IVP - Business Oevelooment I
I ~--------1~ -middotmiddotmiddotmiddotmiddot ~ I
Jeffrie Evans Terri Baumann Brian Stevens carrie Alexander
Marketing amp Curriculum Facilities VP - Finance
Communications Development
I I
Regional Directors of Regional Directors of Operations Academics
campus Directors shyPremier High School shy
Premier High School Campus Staff
I
Or Alan Wimberley Chief Education
Architect
I I
Wesley Cockrum I=Software Kyle Queal
Development - Academics -----I_____
I
I
Responsive Education bullt--------------------------iI R~~~i~~=~~~~=~1Solutions
=~~~~~ I
1rmiddot~middot=middotmiddotmiddot=middot~-~--~middot-I Texas Education
Texas Education Indianapolis MayorsAustin Independent llAgency- Texas College Ohio Council ofd~~Amiddotdcp_p1 [~~
I
Agency- Premier High Office of EducationSchool District - 2 Preparatory Community Schools I State Board of Schools Charter Innovation - 1 School
Sites Academies Charter -5 Schoolsf roved I II Education -4 Charters District - 32 Sites ApprovedI District - 33 Sites Approved
l_ I n=li=middot
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Section V
Admission Policy
Pie e be aware that any change to the terms ofan open-enrollment charter that relates to the following subjects
ade levels bullma middotmum enrollment
hie boundaries bullapprove ampus(es) bull approved s s bull relocation of bull charter holder n e bullcharter school (dis ct) name bull charter campus name bullcharter holder goveman bull articles of incorporation bull corporate bylaws bullmanagement company bull admission policy or bull the educational program of the sch
requires the commissioner ofeducations approva fan amendment (See sectI00 1033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admis middot n are accepted TEC sectI2117 requires that a charter school establish a reasonable application deadline for the 1bmission ofapplications for admission
Beginning of Period (MonthDay)
May4 2015
B If the school admits students by lottery when the number of admissions ap middotcations received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Not applicable
C If the school utilizes a lottery when oversubscribed are any categories ofapplicants exempted from th lottery
0Ycs
0No
0 Not applicable (because lotteries arc not utilized)
If Yes was indicated in C above state the categories ofapplicants that are exempted
Page 11
Section V
Admission Policy
Please be aware that any change to the terms of an open-enrollment charter that relates to the following subjects
bull grade levels bullmaximum enrollment bull geographic boundaries bullapproved campus(es) bull approved sites bull relocation of campus bull charter holdername bull charter school (district) name bull charter campus name bull charter holder governance bull articles of incorporation bullcorporate bylaws bull management company bull admission policy or bullthe educational program of the school
requires the commissioner of educations approval ofan amendment (See sect1001033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadline for the submission ofapplicationsfor admission
Beginning ofPeriod (MonthDay) End of Period (MonthDay)
--~~~-M-ay_4__2_01_s~~~--I l__~~~M_a_y_1_a_2_0_1s~~~---
B If the school admits students by lottery when the number of admissions applications received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Aname (or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) Is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order in which they were drawn Notification of admission will be made and failure of a parent to respond within 48 hours of notification will forfeit his or her position in the lottery
C lfthe school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
0Yes
ONo
0 Not applicable (because lotteries are not utilized)
IfYes was indicated in C above state the categories of annlicants that are exempted
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Page 11
Section V (Continued)
Admission Policy
e school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be con led
Approximate Date of Lottery (MonthDay) ceuroSS ~ ~l-0
NA coll11lGeurolc
0ull-1lG E If the school does not utilize ottery when oversubscribed bu lleuroJSeuro~euroll-l ctole positions in the order in which
applications were received befo the expiration of the applicatil seuroeuro l 11e a first-come first-served admission process) describe the manner in ich the school notifies the ct bull 11unity of the opportunity to apply for admission TEC sect12 117 requires a charter sc of that uses ajirst-comefirst-served admission process when ove1mbscribed to publish a notice in a newspaper ofge1 ral circulation not later than the seventh day before the application deadline
Advertisements are published in the local newspap notifying the community of the Open-Enrollment Period for the school at least seven days before the close of the Ope Enrollment Period
F lfthe school has a separate process for re-enrollment state e process and the timeline to be used
he Re-Enrollment Period will begin May 4 2015 and end May 14 2 15 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 15 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the ignated window as listed above Students who could continue at their current campus but wish to transfer to a different mier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and o in a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application dea ine has passed
If an Application is received from an eligible applicant after the close of the open-enrollment p iod the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely ap ied
H Describe the infom1ation that an applicant must provide in order to be considered for admission Appi ants may not be required to provide copies of transcripts or other academic records until after they are offered od1 middotsion and are enrolling Furthermore a student may not be precluded ji-om enrolling due to the charter schools fail e to receive biformation required for enrollment ji-om the students parent or guardian or previous school See TEC sect2 002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date ofLottery (MonthDay)
0520 APPROVED DURING CONTINGENCY PROCESS
E If the school does not utilize a lottery when oversubscribed but rather fills the available positions in the order in which applications were received before the expiration ofthe application deadline (ie a first-come first-served admission process) describe the manner in which the school notifies the community of the opportunity to apply for admission TEC sect12117 requires a charter school that uses a first-come first-served admission process when oversubscribed to publish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
NIA
F If the school has a separate process for re-enrollment state the process and the timeline to be used
lfhe Re-Enrollment Period will begin May 4 2015 and end May 14 2015 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 2015 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the designated window as listed above Students who could continue at their current campus but wish to transfer to a different Premier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and obtain a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application deadline has passed
If an Application Is received from an eligible applicant after the close of the open-enrollment period the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
H Describe the information that an applicant must provide in order to be considered for admission Applicants may not be required to provide copies of transcripts or other academic records until after they are offered admission and are enrolling Furthermore a student may not be precluded from enrolling due to the charter schools failure to receive information required for enrollment from the students parent or guardian or previous school See TEC sect25002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
I The charter holder certifies that the non-discrimination statement required by TEC sectI2 I I I (a)(5) is printed in the schools admission policy TEC sect121 I I (a)(5) requires that a charter schools admission policy include a statement that the school will not discriminate in admissions based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend
0Ycs
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories ofa criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 3 7 Subchapter A as authorized by TEC sectI21 II (a)(5)(B)
0 Yes (The school excludes such students or reserves the right to exclude such students from admissions)
0 No (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bullA current copy of the admission policy that incorporates the information provided in the above answers to questions
A through H and any other relevant information (Attachment 3)
bull A blank copy of the current admission application ie the information requested when the student first seeks
admission (Attachment 4) and
bullA blank copy of the current enrollment form(s) ie the information required once an applicant has been offered
admission and is registering for enrollment (Attachment 5)
Page 13
I I
i
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Section III
Website Postings
In accordance with the requirements of TEC sect12 1211 an open-enrollment charter school shall list the names of the members of the governing body on the home page of the schools internet website Provide the internet URL address where the names of the members of the governing body are listed
httppremierhighschoolscomtexas-state-requi red-information
In accordance with the requirements of TEC sect12 136 an open-enrollment charter school shall post the salary of the schools superintendent or CEO on the schools internet website Provide the internet URL address where the superintendents salary is posted
httppremierhighschoolscomtexas-state-required-information
In accordance with Local Government Code sect140006 an open-enrollment charter school shall post continuously on the schools internet website the annual financials of the school Provide the internet URL address where the annual financial statements of the charter school are continuously posted
httppremierhighschoolscomtexas-state-required-information
Page9
Section IV
Organizational Charts
Submit as Attachment 1 the organizational chart for the charter school that specifies the administrative positions including the title and name of the individual currently in each position
Submit as Attachment 2 a chart that identifies all other entities under the direction of the charter holder This would include entities andor programs that the charter holder governsmanages in addition to the charter school
Page 10
I I
I I
I
middot~middot==middot==middotmiddotmiddotmiddot~~ Robert Davison liChief Operating O~cj
~1~ middotmiddotmiddotmiddotmiddotmiddot shyOr Mary Ann Duncan Gary Arnold Corey Thomas
VP-School VP - Human InformationI Operations I Resources Technology (IT)
--~~1~-- ---~~~
middotmiddotmiddotmiddotmiddotmiddot-middot -middot~ ----- shy
Kim OLeary PEIMS
ResponsiveEdPremier High Schools
Board of Directors
Chuck Cook Superintendent I
Chief Executive Officer
I Chris eaumaOn bull
General Counsel IVP - Business Oevelooment I
I ~--------1~ -middotmiddotmiddotmiddotmiddot ~ I
Jeffrie Evans Terri Baumann Brian Stevens carrie Alexander
Marketing amp Curriculum Facilities VP - Finance
Communications Development
I I
Regional Directors of Regional Directors of Operations Academics
campus Directors shyPremier High School shy
Premier High School Campus Staff
I
Or Alan Wimberley Chief Education
Architect
I I
Wesley Cockrum I=Software Kyle Queal
Development - Academics -----I_____
I
I
Responsive Education bullt--------------------------iI R~~~i~~=~~~~=~1Solutions
=~~~~~ I
1rmiddot~middot=middotmiddotmiddot=middot~-~--~middot-I Texas Education
Texas Education Indianapolis MayorsAustin Independent llAgency- Texas College Ohio Council ofd~~Amiddotdcp_p1 [~~
I
Agency- Premier High Office of EducationSchool District - 2 Preparatory Community Schools I State Board of Schools Charter Innovation - 1 School
Sites Academies Charter -5 Schoolsf roved I II Education -4 Charters District - 32 Sites ApprovedI District - 33 Sites Approved
l_ I n=li=middot
I ===-middotmiddot--middot
Section V
Admission Policy
Pie e be aware that any change to the terms ofan open-enrollment charter that relates to the following subjects
ade levels bullma middotmum enrollment
hie boundaries bullapprove ampus(es) bull approved s s bull relocation of bull charter holder n e bullcharter school (dis ct) name bull charter campus name bullcharter holder goveman bull articles of incorporation bull corporate bylaws bullmanagement company bull admission policy or bull the educational program of the sch
requires the commissioner ofeducations approva fan amendment (See sectI00 1033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admis middot n are accepted TEC sectI2117 requires that a charter school establish a reasonable application deadline for the 1bmission ofapplications for admission
Beginning of Period (MonthDay)
May4 2015
B If the school admits students by lottery when the number of admissions ap middotcations received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Not applicable
C If the school utilizes a lottery when oversubscribed are any categories ofapplicants exempted from th lottery
0Ycs
0No
0 Not applicable (because lotteries arc not utilized)
If Yes was indicated in C above state the categories ofapplicants that are exempted
Page 11
Section V
Admission Policy
Please be aware that any change to the terms of an open-enrollment charter that relates to the following subjects
bull grade levels bullmaximum enrollment bull geographic boundaries bullapproved campus(es) bull approved sites bull relocation of campus bull charter holdername bull charter school (district) name bull charter campus name bull charter holder governance bull articles of incorporation bullcorporate bylaws bull management company bull admission policy or bullthe educational program of the school
requires the commissioner of educations approval ofan amendment (See sect1001033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadline for the submission ofapplicationsfor admission
Beginning ofPeriod (MonthDay) End of Period (MonthDay)
--~~~-M-ay_4__2_01_s~~~--I l__~~~M_a_y_1_a_2_0_1s~~~---
B If the school admits students by lottery when the number of admissions applications received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Aname (or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) Is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order in which they were drawn Notification of admission will be made and failure of a parent to respond within 48 hours of notification will forfeit his or her position in the lottery
C lfthe school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
0Yes
ONo
0 Not applicable (because lotteries are not utilized)
IfYes was indicated in C above state the categories of annlicants that are exempted
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Page 11
Section V (Continued)
Admission Policy
e school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be con led
Approximate Date of Lottery (MonthDay) ceuroSS ~ ~l-0
NA coll11lGeurolc
0ull-1lG E If the school does not utilize ottery when oversubscribed bu lleuroJSeuro~euroll-l ctole positions in the order in which
applications were received befo the expiration of the applicatil seuroeuro l 11e a first-come first-served admission process) describe the manner in ich the school notifies the ct bull 11unity of the opportunity to apply for admission TEC sect12 117 requires a charter sc of that uses ajirst-comefirst-served admission process when ove1mbscribed to publish a notice in a newspaper ofge1 ral circulation not later than the seventh day before the application deadline
Advertisements are published in the local newspap notifying the community of the Open-Enrollment Period for the school at least seven days before the close of the Ope Enrollment Period
F lfthe school has a separate process for re-enrollment state e process and the timeline to be used
he Re-Enrollment Period will begin May 4 2015 and end May 14 2 15 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 15 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the ignated window as listed above Students who could continue at their current campus but wish to transfer to a different mier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and o in a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application dea ine has passed
If an Application is received from an eligible applicant after the close of the open-enrollment p iod the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely ap ied
H Describe the infom1ation that an applicant must provide in order to be considered for admission Appi ants may not be required to provide copies of transcripts or other academic records until after they are offered od1 middotsion and are enrolling Furthermore a student may not be precluded ji-om enrolling due to the charter schools fail e to receive biformation required for enrollment ji-om the students parent or guardian or previous school See TEC sect2 002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date ofLottery (MonthDay)
0520 APPROVED DURING CONTINGENCY PROCESS
E If the school does not utilize a lottery when oversubscribed but rather fills the available positions in the order in which applications were received before the expiration ofthe application deadline (ie a first-come first-served admission process) describe the manner in which the school notifies the community of the opportunity to apply for admission TEC sect12117 requires a charter school that uses a first-come first-served admission process when oversubscribed to publish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
NIA
F If the school has a separate process for re-enrollment state the process and the timeline to be used
lfhe Re-Enrollment Period will begin May 4 2015 and end May 14 2015 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 2015 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the designated window as listed above Students who could continue at their current campus but wish to transfer to a different Premier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and obtain a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application deadline has passed
If an Application Is received from an eligible applicant after the close of the open-enrollment period the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
H Describe the information that an applicant must provide in order to be considered for admission Applicants may not be required to provide copies of transcripts or other academic records until after they are offered admission and are enrolling Furthermore a student may not be precluded from enrolling due to the charter schools failure to receive information required for enrollment from the students parent or guardian or previous school See TEC sect25002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
I The charter holder certifies that the non-discrimination statement required by TEC sectI2 I I I (a)(5) is printed in the schools admission policy TEC sect121 I I (a)(5) requires that a charter schools admission policy include a statement that the school will not discriminate in admissions based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend
0Ycs
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories ofa criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 3 7 Subchapter A as authorized by TEC sectI21 II (a)(5)(B)
0 Yes (The school excludes such students or reserves the right to exclude such students from admissions)
0 No (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bullA current copy of the admission policy that incorporates the information provided in the above answers to questions
A through H and any other relevant information (Attachment 3)
bull A blank copy of the current admission application ie the information requested when the student first seeks
admission (Attachment 4) and
bullA blank copy of the current enrollment form(s) ie the information required once an applicant has been offered
admission and is registering for enrollment (Attachment 5)
Page 13
I I
i
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Section IV
Organizational Charts
Submit as Attachment 1 the organizational chart for the charter school that specifies the administrative positions including the title and name of the individual currently in each position
Submit as Attachment 2 a chart that identifies all other entities under the direction of the charter holder This would include entities andor programs that the charter holder governsmanages in addition to the charter school
Page 10
I I
I I
I
middot~middot==middot==middotmiddotmiddotmiddot~~ Robert Davison liChief Operating O~cj
~1~ middotmiddotmiddotmiddotmiddotmiddot shyOr Mary Ann Duncan Gary Arnold Corey Thomas
VP-School VP - Human InformationI Operations I Resources Technology (IT)
--~~1~-- ---~~~
middotmiddotmiddotmiddotmiddotmiddot-middot -middot~ ----- shy
Kim OLeary PEIMS
ResponsiveEdPremier High Schools
Board of Directors
Chuck Cook Superintendent I
Chief Executive Officer
I Chris eaumaOn bull
General Counsel IVP - Business Oevelooment I
I ~--------1~ -middotmiddotmiddotmiddotmiddot ~ I
Jeffrie Evans Terri Baumann Brian Stevens carrie Alexander
Marketing amp Curriculum Facilities VP - Finance
Communications Development
I I
Regional Directors of Regional Directors of Operations Academics
campus Directors shyPremier High School shy
Premier High School Campus Staff
I
Or Alan Wimberley Chief Education
Architect
I I
Wesley Cockrum I=Software Kyle Queal
Development - Academics -----I_____
I
I
Responsive Education bullt--------------------------iI R~~~i~~=~~~~=~1Solutions
=~~~~~ I
1rmiddot~middot=middotmiddotmiddot=middot~-~--~middot-I Texas Education
Texas Education Indianapolis MayorsAustin Independent llAgency- Texas College Ohio Council ofd~~Amiddotdcp_p1 [~~
I
Agency- Premier High Office of EducationSchool District - 2 Preparatory Community Schools I State Board of Schools Charter Innovation - 1 School
Sites Academies Charter -5 Schoolsf roved I II Education -4 Charters District - 32 Sites ApprovedI District - 33 Sites Approved
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Section V
Admission Policy
Pie e be aware that any change to the terms ofan open-enrollment charter that relates to the following subjects
ade levels bullma middotmum enrollment
hie boundaries bullapprove ampus(es) bull approved s s bull relocation of bull charter holder n e bullcharter school (dis ct) name bull charter campus name bullcharter holder goveman bull articles of incorporation bull corporate bylaws bullmanagement company bull admission policy or bull the educational program of the sch
requires the commissioner ofeducations approva fan amendment (See sectI00 1033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admis middot n are accepted TEC sectI2117 requires that a charter school establish a reasonable application deadline for the 1bmission ofapplications for admission
Beginning of Period (MonthDay)
May4 2015
B If the school admits students by lottery when the number of admissions ap middotcations received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Not applicable
C If the school utilizes a lottery when oversubscribed are any categories ofapplicants exempted from th lottery
0Ycs
0No
0 Not applicable (because lotteries arc not utilized)
If Yes was indicated in C above state the categories ofapplicants that are exempted
Page 11
Section V
Admission Policy
Please be aware that any change to the terms of an open-enrollment charter that relates to the following subjects
bull grade levels bullmaximum enrollment bull geographic boundaries bullapproved campus(es) bull approved sites bull relocation of campus bull charter holdername bull charter school (district) name bull charter campus name bull charter holder governance bull articles of incorporation bullcorporate bylaws bull management company bull admission policy or bullthe educational program of the school
requires the commissioner of educations approval ofan amendment (See sect1001033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadline for the submission ofapplicationsfor admission
Beginning ofPeriod (MonthDay) End of Period (MonthDay)
--~~~-M-ay_4__2_01_s~~~--I l__~~~M_a_y_1_a_2_0_1s~~~---
B If the school admits students by lottery when the number of admissions applications received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Aname (or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) Is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order in which they were drawn Notification of admission will be made and failure of a parent to respond within 48 hours of notification will forfeit his or her position in the lottery
C lfthe school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
0Yes
ONo
0 Not applicable (because lotteries are not utilized)
IfYes was indicated in C above state the categories of annlicants that are exempted
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Page 11
Section V (Continued)
Admission Policy
e school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be con led
Approximate Date of Lottery (MonthDay) ceuroSS ~ ~l-0
NA coll11lGeurolc
0ull-1lG E If the school does not utilize ottery when oversubscribed bu lleuroJSeuro~euroll-l ctole positions in the order in which
applications were received befo the expiration of the applicatil seuroeuro l 11e a first-come first-served admission process) describe the manner in ich the school notifies the ct bull 11unity of the opportunity to apply for admission TEC sect12 117 requires a charter sc of that uses ajirst-comefirst-served admission process when ove1mbscribed to publish a notice in a newspaper ofge1 ral circulation not later than the seventh day before the application deadline
Advertisements are published in the local newspap notifying the community of the Open-Enrollment Period for the school at least seven days before the close of the Ope Enrollment Period
F lfthe school has a separate process for re-enrollment state e process and the timeline to be used
he Re-Enrollment Period will begin May 4 2015 and end May 14 2 15 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 15 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the ignated window as listed above Students who could continue at their current campus but wish to transfer to a different mier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and o in a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application dea ine has passed
If an Application is received from an eligible applicant after the close of the open-enrollment p iod the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely ap ied
H Describe the infom1ation that an applicant must provide in order to be considered for admission Appi ants may not be required to provide copies of transcripts or other academic records until after they are offered od1 middotsion and are enrolling Furthermore a student may not be precluded ji-om enrolling due to the charter schools fail e to receive biformation required for enrollment ji-om the students parent or guardian or previous school See TEC sect2 002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date ofLottery (MonthDay)
0520 APPROVED DURING CONTINGENCY PROCESS
E If the school does not utilize a lottery when oversubscribed but rather fills the available positions in the order in which applications were received before the expiration ofthe application deadline (ie a first-come first-served admission process) describe the manner in which the school notifies the community of the opportunity to apply for admission TEC sect12117 requires a charter school that uses a first-come first-served admission process when oversubscribed to publish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
NIA
F If the school has a separate process for re-enrollment state the process and the timeline to be used
lfhe Re-Enrollment Period will begin May 4 2015 and end May 14 2015 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 2015 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the designated window as listed above Students who could continue at their current campus but wish to transfer to a different Premier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and obtain a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application deadline has passed
If an Application Is received from an eligible applicant after the close of the open-enrollment period the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
H Describe the information that an applicant must provide in order to be considered for admission Applicants may not be required to provide copies of transcripts or other academic records until after they are offered admission and are enrolling Furthermore a student may not be precluded from enrolling due to the charter schools failure to receive information required for enrollment from the students parent or guardian or previous school See TEC sect25002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
I The charter holder certifies that the non-discrimination statement required by TEC sectI2 I I I (a)(5) is printed in the schools admission policy TEC sect121 I I (a)(5) requires that a charter schools admission policy include a statement that the school will not discriminate in admissions based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend
0Ycs
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories ofa criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 3 7 Subchapter A as authorized by TEC sectI21 II (a)(5)(B)
0 Yes (The school excludes such students or reserves the right to exclude such students from admissions)
0 No (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bullA current copy of the admission policy that incorporates the information provided in the above answers to questions
A through H and any other relevant information (Attachment 3)
bull A blank copy of the current admission application ie the information requested when the student first seeks
admission (Attachment 4) and
bullA blank copy of the current enrollment form(s) ie the information required once an applicant has been offered
admission and is registering for enrollment (Attachment 5)
Page 13
I I
i
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
I I
I I
I
middot~middot==middot==middotmiddotmiddotmiddot~~ Robert Davison liChief Operating O~cj
~1~ middotmiddotmiddotmiddotmiddotmiddot shyOr Mary Ann Duncan Gary Arnold Corey Thomas
VP-School VP - Human InformationI Operations I Resources Technology (IT)
--~~1~-- ---~~~
middotmiddotmiddotmiddotmiddotmiddot-middot -middot~ ----- shy
Kim OLeary PEIMS
ResponsiveEdPremier High Schools
Board of Directors
Chuck Cook Superintendent I
Chief Executive Officer
I Chris eaumaOn bull
General Counsel IVP - Business Oevelooment I
I ~--------1~ -middotmiddotmiddotmiddotmiddot ~ I
Jeffrie Evans Terri Baumann Brian Stevens carrie Alexander
Marketing amp Curriculum Facilities VP - Finance
Communications Development
I I
Regional Directors of Regional Directors of Operations Academics
campus Directors shyPremier High School shy
Premier High School Campus Staff
I
Or Alan Wimberley Chief Education
Architect
I I
Wesley Cockrum I=Software Kyle Queal
Development - Academics -----I_____
I
I
Responsive Education bullt--------------------------iI R~~~i~~=~~~~=~1Solutions
=~~~~~ I
1rmiddot~middot=middotmiddotmiddot=middot~-~--~middot-I Texas Education
Texas Education Indianapolis MayorsAustin Independent llAgency- Texas College Ohio Council ofd~~Amiddotdcp_p1 [~~
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Agency- Premier High Office of EducationSchool District - 2 Preparatory Community Schools I State Board of Schools Charter Innovation - 1 School
Sites Academies Charter -5 Schoolsf roved I II Education -4 Charters District - 32 Sites ApprovedI District - 33 Sites Approved
l_ I n=li=middot
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Section V
Admission Policy
Pie e be aware that any change to the terms ofan open-enrollment charter that relates to the following subjects
ade levels bullma middotmum enrollment
hie boundaries bullapprove ampus(es) bull approved s s bull relocation of bull charter holder n e bullcharter school (dis ct) name bull charter campus name bullcharter holder goveman bull articles of incorporation bull corporate bylaws bullmanagement company bull admission policy or bull the educational program of the sch
requires the commissioner ofeducations approva fan amendment (See sectI00 1033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admis middot n are accepted TEC sectI2117 requires that a charter school establish a reasonable application deadline for the 1bmission ofapplications for admission
Beginning of Period (MonthDay)
May4 2015
B If the school admits students by lottery when the number of admissions ap middotcations received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Not applicable
C If the school utilizes a lottery when oversubscribed are any categories ofapplicants exempted from th lottery
0Ycs
0No
0 Not applicable (because lotteries arc not utilized)
If Yes was indicated in C above state the categories ofapplicants that are exempted
Page 11
Section V
Admission Policy
Please be aware that any change to the terms of an open-enrollment charter that relates to the following subjects
bull grade levels bullmaximum enrollment bull geographic boundaries bullapproved campus(es) bull approved sites bull relocation of campus bull charter holdername bull charter school (district) name bull charter campus name bull charter holder governance bull articles of incorporation bullcorporate bylaws bull management company bull admission policy or bullthe educational program of the school
requires the commissioner of educations approval ofan amendment (See sect1001033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadline for the submission ofapplicationsfor admission
Beginning ofPeriod (MonthDay) End of Period (MonthDay)
--~~~-M-ay_4__2_01_s~~~--I l__~~~M_a_y_1_a_2_0_1s~~~---
B If the school admits students by lottery when the number of admissions applications received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Aname (or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) Is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order in which they were drawn Notification of admission will be made and failure of a parent to respond within 48 hours of notification will forfeit his or her position in the lottery
C lfthe school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
0Yes
ONo
0 Not applicable (because lotteries are not utilized)
IfYes was indicated in C above state the categories of annlicants that are exempted
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Page 11
Section V (Continued)
Admission Policy
e school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be con led
Approximate Date of Lottery (MonthDay) ceuroSS ~ ~l-0
NA coll11lGeurolc
0ull-1lG E If the school does not utilize ottery when oversubscribed bu lleuroJSeuro~euroll-l ctole positions in the order in which
applications were received befo the expiration of the applicatil seuroeuro l 11e a first-come first-served admission process) describe the manner in ich the school notifies the ct bull 11unity of the opportunity to apply for admission TEC sect12 117 requires a charter sc of that uses ajirst-comefirst-served admission process when ove1mbscribed to publish a notice in a newspaper ofge1 ral circulation not later than the seventh day before the application deadline
Advertisements are published in the local newspap notifying the community of the Open-Enrollment Period for the school at least seven days before the close of the Ope Enrollment Period
F lfthe school has a separate process for re-enrollment state e process and the timeline to be used
he Re-Enrollment Period will begin May 4 2015 and end May 14 2 15 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 15 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the ignated window as listed above Students who could continue at their current campus but wish to transfer to a different mier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and o in a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application dea ine has passed
If an Application is received from an eligible applicant after the close of the open-enrollment p iod the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely ap ied
H Describe the infom1ation that an applicant must provide in order to be considered for admission Appi ants may not be required to provide copies of transcripts or other academic records until after they are offered od1 middotsion and are enrolling Furthermore a student may not be precluded ji-om enrolling due to the charter schools fail e to receive biformation required for enrollment ji-om the students parent or guardian or previous school See TEC sect2 002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date ofLottery (MonthDay)
0520 APPROVED DURING CONTINGENCY PROCESS
E If the school does not utilize a lottery when oversubscribed but rather fills the available positions in the order in which applications were received before the expiration ofthe application deadline (ie a first-come first-served admission process) describe the manner in which the school notifies the community of the opportunity to apply for admission TEC sect12117 requires a charter school that uses a first-come first-served admission process when oversubscribed to publish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
NIA
F If the school has a separate process for re-enrollment state the process and the timeline to be used
lfhe Re-Enrollment Period will begin May 4 2015 and end May 14 2015 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 2015 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the designated window as listed above Students who could continue at their current campus but wish to transfer to a different Premier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and obtain a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application deadline has passed
If an Application Is received from an eligible applicant after the close of the open-enrollment period the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
H Describe the information that an applicant must provide in order to be considered for admission Applicants may not be required to provide copies of transcripts or other academic records until after they are offered admission and are enrolling Furthermore a student may not be precluded from enrolling due to the charter schools failure to receive information required for enrollment from the students parent or guardian or previous school See TEC sect25002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
I The charter holder certifies that the non-discrimination statement required by TEC sectI2 I I I (a)(5) is printed in the schools admission policy TEC sect121 I I (a)(5) requires that a charter schools admission policy include a statement that the school will not discriminate in admissions based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend
0Ycs
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories ofa criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 3 7 Subchapter A as authorized by TEC sectI21 II (a)(5)(B)
0 Yes (The school excludes such students or reserves the right to exclude such students from admissions)
0 No (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bullA current copy of the admission policy that incorporates the information provided in the above answers to questions
A through H and any other relevant information (Attachment 3)
bull A blank copy of the current admission application ie the information requested when the student first seeks
admission (Attachment 4) and
bullA blank copy of the current enrollment form(s) ie the information required once an applicant has been offered
admission and is registering for enrollment (Attachment 5)
Page 13
I I
i
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
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middot~middot==middot==middotmiddotmiddotmiddot~~ Robert Davison liChief Operating O~cj
~1~ middotmiddotmiddotmiddotmiddotmiddot shyOr Mary Ann Duncan Gary Arnold Corey Thomas
VP-School VP - Human InformationI Operations I Resources Technology (IT)
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middotmiddotmiddotmiddotmiddotmiddot-middot -middot~ ----- shy
Kim OLeary PEIMS
ResponsiveEdPremier High Schools
Board of Directors
Chuck Cook Superintendent I
Chief Executive Officer
I Chris eaumaOn bull
General Counsel IVP - Business Oevelooment I
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Jeffrie Evans Terri Baumann Brian Stevens carrie Alexander
Marketing amp Curriculum Facilities VP - Finance
Communications Development
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Regional Directors of Regional Directors of Operations Academics
campus Directors shyPremier High School shy
Premier High School Campus Staff
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Or Alan Wimberley Chief Education
Architect
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Wesley Cockrum I=Software Kyle Queal
Development - Academics -----I_____
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Responsive Education bullt--------------------------iI R~~~i~~=~~~~=~1Solutions
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Texas Education Indianapolis MayorsAustin Independent llAgency- Texas College Ohio Council ofd~~Amiddotdcp_p1 [~~
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Section V
Admission Policy
Pie e be aware that any change to the terms ofan open-enrollment charter that relates to the following subjects
ade levels bullma middotmum enrollment
hie boundaries bullapprove ampus(es) bull approved s s bull relocation of bull charter holder n e bullcharter school (dis ct) name bull charter campus name bullcharter holder goveman bull articles of incorporation bull corporate bylaws bullmanagement company bull admission policy or bull the educational program of the sch
requires the commissioner ofeducations approva fan amendment (See sectI00 1033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admis middot n are accepted TEC sectI2117 requires that a charter school establish a reasonable application deadline for the 1bmission ofapplications for admission
Beginning of Period (MonthDay)
May4 2015
B If the school admits students by lottery when the number of admissions ap middotcations received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Not applicable
C If the school utilizes a lottery when oversubscribed are any categories ofapplicants exempted from th lottery
0Ycs
0No
0 Not applicable (because lotteries arc not utilized)
If Yes was indicated in C above state the categories ofapplicants that are exempted
Page 11
Section V
Admission Policy
Please be aware that any change to the terms of an open-enrollment charter that relates to the following subjects
bull grade levels bullmaximum enrollment bull geographic boundaries bullapproved campus(es) bull approved sites bull relocation of campus bull charter holdername bull charter school (district) name bull charter campus name bull charter holder governance bull articles of incorporation bullcorporate bylaws bull management company bull admission policy or bullthe educational program of the school
requires the commissioner of educations approval ofan amendment (See sect1001033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadline for the submission ofapplicationsfor admission
Beginning ofPeriod (MonthDay) End of Period (MonthDay)
--~~~-M-ay_4__2_01_s~~~--I l__~~~M_a_y_1_a_2_0_1s~~~---
B If the school admits students by lottery when the number of admissions applications received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Aname (or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) Is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order in which they were drawn Notification of admission will be made and failure of a parent to respond within 48 hours of notification will forfeit his or her position in the lottery
C lfthe school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
0Yes
ONo
0 Not applicable (because lotteries are not utilized)
IfYes was indicated in C above state the categories of annlicants that are exempted
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Page 11
Section V (Continued)
Admission Policy
e school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be con led
Approximate Date of Lottery (MonthDay) ceuroSS ~ ~l-0
NA coll11lGeurolc
0ull-1lG E If the school does not utilize ottery when oversubscribed bu lleuroJSeuro~euroll-l ctole positions in the order in which
applications were received befo the expiration of the applicatil seuroeuro l 11e a first-come first-served admission process) describe the manner in ich the school notifies the ct bull 11unity of the opportunity to apply for admission TEC sect12 117 requires a charter sc of that uses ajirst-comefirst-served admission process when ove1mbscribed to publish a notice in a newspaper ofge1 ral circulation not later than the seventh day before the application deadline
Advertisements are published in the local newspap notifying the community of the Open-Enrollment Period for the school at least seven days before the close of the Ope Enrollment Period
F lfthe school has a separate process for re-enrollment state e process and the timeline to be used
he Re-Enrollment Period will begin May 4 2015 and end May 14 2 15 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 15 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the ignated window as listed above Students who could continue at their current campus but wish to transfer to a different mier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and o in a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application dea ine has passed
If an Application is received from an eligible applicant after the close of the open-enrollment p iod the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely ap ied
H Describe the infom1ation that an applicant must provide in order to be considered for admission Appi ants may not be required to provide copies of transcripts or other academic records until after they are offered od1 middotsion and are enrolling Furthermore a student may not be precluded ji-om enrolling due to the charter schools fail e to receive biformation required for enrollment ji-om the students parent or guardian or previous school See TEC sect2 002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date ofLottery (MonthDay)
0520 APPROVED DURING CONTINGENCY PROCESS
E If the school does not utilize a lottery when oversubscribed but rather fills the available positions in the order in which applications were received before the expiration ofthe application deadline (ie a first-come first-served admission process) describe the manner in which the school notifies the community of the opportunity to apply for admission TEC sect12117 requires a charter school that uses a first-come first-served admission process when oversubscribed to publish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
NIA
F If the school has a separate process for re-enrollment state the process and the timeline to be used
lfhe Re-Enrollment Period will begin May 4 2015 and end May 14 2015 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 2015 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the designated window as listed above Students who could continue at their current campus but wish to transfer to a different Premier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and obtain a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application deadline has passed
If an Application Is received from an eligible applicant after the close of the open-enrollment period the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
H Describe the information that an applicant must provide in order to be considered for admission Applicants may not be required to provide copies of transcripts or other academic records until after they are offered admission and are enrolling Furthermore a student may not be precluded from enrolling due to the charter schools failure to receive information required for enrollment from the students parent or guardian or previous school See TEC sect25002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
I The charter holder certifies that the non-discrimination statement required by TEC sectI2 I I I (a)(5) is printed in the schools admission policy TEC sect121 I I (a)(5) requires that a charter schools admission policy include a statement that the school will not discriminate in admissions based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend
0Ycs
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories ofa criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 3 7 Subchapter A as authorized by TEC sectI21 II (a)(5)(B)
0 Yes (The school excludes such students or reserves the right to exclude such students from admissions)
0 No (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bullA current copy of the admission policy that incorporates the information provided in the above answers to questions
A through H and any other relevant information (Attachment 3)
bull A blank copy of the current admission application ie the information requested when the student first seeks
admission (Attachment 4) and
bullA blank copy of the current enrollment form(s) ie the information required once an applicant has been offered
admission and is registering for enrollment (Attachment 5)
Page 13
I I
i
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
I
Responsive Education bullt--------------------------iI R~~~i~~=~~~~=~1Solutions
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Texas Education Indianapolis MayorsAustin Independent llAgency- Texas College Ohio Council ofd~~Amiddotdcp_p1 [~~
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Agency- Premier High Office of EducationSchool District - 2 Preparatory Community Schools I State Board of Schools Charter Innovation - 1 School
Sites Academies Charter -5 Schoolsf roved I II Education -4 Charters District - 32 Sites ApprovedI District - 33 Sites Approved
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Section V
Admission Policy
Pie e be aware that any change to the terms ofan open-enrollment charter that relates to the following subjects
ade levels bullma middotmum enrollment
hie boundaries bullapprove ampus(es) bull approved s s bull relocation of bull charter holder n e bullcharter school (dis ct) name bull charter campus name bullcharter holder goveman bull articles of incorporation bull corporate bylaws bullmanagement company bull admission policy or bull the educational program of the sch
requires the commissioner ofeducations approva fan amendment (See sectI00 1033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admis middot n are accepted TEC sectI2117 requires that a charter school establish a reasonable application deadline for the 1bmission ofapplications for admission
Beginning of Period (MonthDay)
May4 2015
B If the school admits students by lottery when the number of admissions ap middotcations received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Not applicable
C If the school utilizes a lottery when oversubscribed are any categories ofapplicants exempted from th lottery
0Ycs
0No
0 Not applicable (because lotteries arc not utilized)
If Yes was indicated in C above state the categories ofapplicants that are exempted
Page 11
Section V
Admission Policy
Please be aware that any change to the terms of an open-enrollment charter that relates to the following subjects
bull grade levels bullmaximum enrollment bull geographic boundaries bullapproved campus(es) bull approved sites bull relocation of campus bull charter holdername bull charter school (district) name bull charter campus name bull charter holder governance bull articles of incorporation bullcorporate bylaws bull management company bull admission policy or bullthe educational program of the school
requires the commissioner of educations approval ofan amendment (See sect1001033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadline for the submission ofapplicationsfor admission
Beginning ofPeriod (MonthDay) End of Period (MonthDay)
--~~~-M-ay_4__2_01_s~~~--I l__~~~M_a_y_1_a_2_0_1s~~~---
B If the school admits students by lottery when the number of admissions applications received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Aname (or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) Is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order in which they were drawn Notification of admission will be made and failure of a parent to respond within 48 hours of notification will forfeit his or her position in the lottery
C lfthe school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
0Yes
ONo
0 Not applicable (because lotteries are not utilized)
IfYes was indicated in C above state the categories of annlicants that are exempted
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Page 11
Section V (Continued)
Admission Policy
e school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be con led
Approximate Date of Lottery (MonthDay) ceuroSS ~ ~l-0
NA coll11lGeurolc
0ull-1lG E If the school does not utilize ottery when oversubscribed bu lleuroJSeuro~euroll-l ctole positions in the order in which
applications were received befo the expiration of the applicatil seuroeuro l 11e a first-come first-served admission process) describe the manner in ich the school notifies the ct bull 11unity of the opportunity to apply for admission TEC sect12 117 requires a charter sc of that uses ajirst-comefirst-served admission process when ove1mbscribed to publish a notice in a newspaper ofge1 ral circulation not later than the seventh day before the application deadline
Advertisements are published in the local newspap notifying the community of the Open-Enrollment Period for the school at least seven days before the close of the Ope Enrollment Period
F lfthe school has a separate process for re-enrollment state e process and the timeline to be used
he Re-Enrollment Period will begin May 4 2015 and end May 14 2 15 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 15 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the ignated window as listed above Students who could continue at their current campus but wish to transfer to a different mier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and o in a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application dea ine has passed
If an Application is received from an eligible applicant after the close of the open-enrollment p iod the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely ap ied
H Describe the infom1ation that an applicant must provide in order to be considered for admission Appi ants may not be required to provide copies of transcripts or other academic records until after they are offered od1 middotsion and are enrolling Furthermore a student may not be precluded ji-om enrolling due to the charter schools fail e to receive biformation required for enrollment ji-om the students parent or guardian or previous school See TEC sect2 002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date ofLottery (MonthDay)
0520 APPROVED DURING CONTINGENCY PROCESS
E If the school does not utilize a lottery when oversubscribed but rather fills the available positions in the order in which applications were received before the expiration ofthe application deadline (ie a first-come first-served admission process) describe the manner in which the school notifies the community of the opportunity to apply for admission TEC sect12117 requires a charter school that uses a first-come first-served admission process when oversubscribed to publish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
NIA
F If the school has a separate process for re-enrollment state the process and the timeline to be used
lfhe Re-Enrollment Period will begin May 4 2015 and end May 14 2015 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 2015 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the designated window as listed above Students who could continue at their current campus but wish to transfer to a different Premier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and obtain a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application deadline has passed
If an Application Is received from an eligible applicant after the close of the open-enrollment period the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
H Describe the information that an applicant must provide in order to be considered for admission Applicants may not be required to provide copies of transcripts or other academic records until after they are offered admission and are enrolling Furthermore a student may not be precluded from enrolling due to the charter schools failure to receive information required for enrollment from the students parent or guardian or previous school See TEC sect25002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
I The charter holder certifies that the non-discrimination statement required by TEC sectI2 I I I (a)(5) is printed in the schools admission policy TEC sect121 I I (a)(5) requires that a charter schools admission policy include a statement that the school will not discriminate in admissions based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend
0Ycs
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories ofa criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 3 7 Subchapter A as authorized by TEC sectI21 II (a)(5)(B)
0 Yes (The school excludes such students or reserves the right to exclude such students from admissions)
0 No (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bullA current copy of the admission policy that incorporates the information provided in the above answers to questions
A through H and any other relevant information (Attachment 3)
bull A blank copy of the current admission application ie the information requested when the student first seeks
admission (Attachment 4) and
bullA blank copy of the current enrollment form(s) ie the information required once an applicant has been offered
admission and is registering for enrollment (Attachment 5)
Page 13
I I
i
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Section V
Admission Policy
Pie e be aware that any change to the terms ofan open-enrollment charter that relates to the following subjects
ade levels bullma middotmum enrollment
hie boundaries bullapprove ampus(es) bull approved s s bull relocation of bull charter holder n e bullcharter school (dis ct) name bull charter campus name bullcharter holder goveman bull articles of incorporation bull corporate bylaws bullmanagement company bull admission policy or bull the educational program of the sch
requires the commissioner ofeducations approva fan amendment (See sectI00 1033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admis middot n are accepted TEC sectI2117 requires that a charter school establish a reasonable application deadline for the 1bmission ofapplications for admission
Beginning of Period (MonthDay)
May4 2015
B If the school admits students by lottery when the number of admissions ap middotcations received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Not applicable
C If the school utilizes a lottery when oversubscribed are any categories ofapplicants exempted from th lottery
0Ycs
0No
0 Not applicable (because lotteries arc not utilized)
If Yes was indicated in C above state the categories ofapplicants that are exempted
Page 11
Section V
Admission Policy
Please be aware that any change to the terms of an open-enrollment charter that relates to the following subjects
bull grade levels bullmaximum enrollment bull geographic boundaries bullapproved campus(es) bull approved sites bull relocation of campus bull charter holdername bull charter school (district) name bull charter campus name bull charter holder governance bull articles of incorporation bullcorporate bylaws bull management company bull admission policy or bullthe educational program of the school
requires the commissioner of educations approval ofan amendment (See sect1001033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadline for the submission ofapplicationsfor admission
Beginning ofPeriod (MonthDay) End of Period (MonthDay)
--~~~-M-ay_4__2_01_s~~~--I l__~~~M_a_y_1_a_2_0_1s~~~---
B If the school admits students by lottery when the number of admissions applications received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Aname (or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) Is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order in which they were drawn Notification of admission will be made and failure of a parent to respond within 48 hours of notification will forfeit his or her position in the lottery
C lfthe school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
0Yes
ONo
0 Not applicable (because lotteries are not utilized)
IfYes was indicated in C above state the categories of annlicants that are exempted
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Page 11
Section V (Continued)
Admission Policy
e school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be con led
Approximate Date of Lottery (MonthDay) ceuroSS ~ ~l-0
NA coll11lGeurolc
0ull-1lG E If the school does not utilize ottery when oversubscribed bu lleuroJSeuro~euroll-l ctole positions in the order in which
applications were received befo the expiration of the applicatil seuroeuro l 11e a first-come first-served admission process) describe the manner in ich the school notifies the ct bull 11unity of the opportunity to apply for admission TEC sect12 117 requires a charter sc of that uses ajirst-comefirst-served admission process when ove1mbscribed to publish a notice in a newspaper ofge1 ral circulation not later than the seventh day before the application deadline
Advertisements are published in the local newspap notifying the community of the Open-Enrollment Period for the school at least seven days before the close of the Ope Enrollment Period
F lfthe school has a separate process for re-enrollment state e process and the timeline to be used
he Re-Enrollment Period will begin May 4 2015 and end May 14 2 15 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 15 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the ignated window as listed above Students who could continue at their current campus but wish to transfer to a different mier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and o in a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application dea ine has passed
If an Application is received from an eligible applicant after the close of the open-enrollment p iod the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely ap ied
H Describe the infom1ation that an applicant must provide in order to be considered for admission Appi ants may not be required to provide copies of transcripts or other academic records until after they are offered od1 middotsion and are enrolling Furthermore a student may not be precluded ji-om enrolling due to the charter schools fail e to receive biformation required for enrollment ji-om the students parent or guardian or previous school See TEC sect2 002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date ofLottery (MonthDay)
0520 APPROVED DURING CONTINGENCY PROCESS
E If the school does not utilize a lottery when oversubscribed but rather fills the available positions in the order in which applications were received before the expiration ofthe application deadline (ie a first-come first-served admission process) describe the manner in which the school notifies the community of the opportunity to apply for admission TEC sect12117 requires a charter school that uses a first-come first-served admission process when oversubscribed to publish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
NIA
F If the school has a separate process for re-enrollment state the process and the timeline to be used
lfhe Re-Enrollment Period will begin May 4 2015 and end May 14 2015 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 2015 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the designated window as listed above Students who could continue at their current campus but wish to transfer to a different Premier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and obtain a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application deadline has passed
If an Application Is received from an eligible applicant after the close of the open-enrollment period the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
H Describe the information that an applicant must provide in order to be considered for admission Applicants may not be required to provide copies of transcripts or other academic records until after they are offered admission and are enrolling Furthermore a student may not be precluded from enrolling due to the charter schools failure to receive information required for enrollment from the students parent or guardian or previous school See TEC sect25002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
I The charter holder certifies that the non-discrimination statement required by TEC sectI2 I I I (a)(5) is printed in the schools admission policy TEC sect121 I I (a)(5) requires that a charter schools admission policy include a statement that the school will not discriminate in admissions based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend
0Ycs
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories ofa criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 3 7 Subchapter A as authorized by TEC sectI21 II (a)(5)(B)
0 Yes (The school excludes such students or reserves the right to exclude such students from admissions)
0 No (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bullA current copy of the admission policy that incorporates the information provided in the above answers to questions
A through H and any other relevant information (Attachment 3)
bull A blank copy of the current admission application ie the information requested when the student first seeks
admission (Attachment 4) and
bullA blank copy of the current enrollment form(s) ie the information required once an applicant has been offered
admission and is registering for enrollment (Attachment 5)
Page 13
I I
i
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Section V
Admission Policy
Please be aware that any change to the terms of an open-enrollment charter that relates to the following subjects
bull grade levels bullmaximum enrollment bull geographic boundaries bullapproved campus(es) bull approved sites bull relocation of campus bull charter holdername bull charter school (district) name bull charter campus name bull charter holder governance bull articles of incorporation bullcorporate bylaws bull management company bull admission policy or bullthe educational program of the school
requires the commissioner of educations approval ofan amendment (See sect1001033(b) Types of amendments 19 TAC Chapter JOO)
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadline for the submission ofapplicationsfor admission
Beginning ofPeriod (MonthDay) End of Period (MonthDay)
--~~~-M-ay_4__2_01_s~~~--I l__~~~M_a_y_1_a_2_0_1s~~~---
B If the school admits students by lottery when the number of admissions applications received exceeds the number of available spaces describe the procedures followed in conducting the lottery
Aname (or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) Is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order in which they were drawn Notification of admission will be made and failure of a parent to respond within 48 hours of notification will forfeit his or her position in the lottery
C lfthe school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
0Yes
ONo
0 Not applicable (because lotteries are not utilized)
IfYes was indicated in C above state the categories of annlicants that are exempted
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Page 11
Section V (Continued)
Admission Policy
e school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be con led
Approximate Date of Lottery (MonthDay) ceuroSS ~ ~l-0
NA coll11lGeurolc
0ull-1lG E If the school does not utilize ottery when oversubscribed bu lleuroJSeuro~euroll-l ctole positions in the order in which
applications were received befo the expiration of the applicatil seuroeuro l 11e a first-come first-served admission process) describe the manner in ich the school notifies the ct bull 11unity of the opportunity to apply for admission TEC sect12 117 requires a charter sc of that uses ajirst-comefirst-served admission process when ove1mbscribed to publish a notice in a newspaper ofge1 ral circulation not later than the seventh day before the application deadline
Advertisements are published in the local newspap notifying the community of the Open-Enrollment Period for the school at least seven days before the close of the Ope Enrollment Period
F lfthe school has a separate process for re-enrollment state e process and the timeline to be used
he Re-Enrollment Period will begin May 4 2015 and end May 14 2 15 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 15 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the ignated window as listed above Students who could continue at their current campus but wish to transfer to a different mier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and o in a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application dea ine has passed
If an Application is received from an eligible applicant after the close of the open-enrollment p iod the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely ap ied
H Describe the infom1ation that an applicant must provide in order to be considered for admission Appi ants may not be required to provide copies of transcripts or other academic records until after they are offered od1 middotsion and are enrolling Furthermore a student may not be precluded ji-om enrolling due to the charter schools fail e to receive biformation required for enrollment ji-om the students parent or guardian or previous school See TEC sect2 002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date ofLottery (MonthDay)
0520 APPROVED DURING CONTINGENCY PROCESS
E If the school does not utilize a lottery when oversubscribed but rather fills the available positions in the order in which applications were received before the expiration ofthe application deadline (ie a first-come first-served admission process) describe the manner in which the school notifies the community of the opportunity to apply for admission TEC sect12117 requires a charter school that uses a first-come first-served admission process when oversubscribed to publish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
NIA
F If the school has a separate process for re-enrollment state the process and the timeline to be used
lfhe Re-Enrollment Period will begin May 4 2015 and end May 14 2015 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 2015 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the designated window as listed above Students who could continue at their current campus but wish to transfer to a different Premier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and obtain a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application deadline has passed
If an Application Is received from an eligible applicant after the close of the open-enrollment period the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
H Describe the information that an applicant must provide in order to be considered for admission Applicants may not be required to provide copies of transcripts or other academic records until after they are offered admission and are enrolling Furthermore a student may not be precluded from enrolling due to the charter schools failure to receive information required for enrollment from the students parent or guardian or previous school See TEC sect25002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
I The charter holder certifies that the non-discrimination statement required by TEC sectI2 I I I (a)(5) is printed in the schools admission policy TEC sect121 I I (a)(5) requires that a charter schools admission policy include a statement that the school will not discriminate in admissions based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend
0Ycs
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories ofa criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 3 7 Subchapter A as authorized by TEC sectI21 II (a)(5)(B)
0 Yes (The school excludes such students or reserves the right to exclude such students from admissions)
0 No (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bullA current copy of the admission policy that incorporates the information provided in the above answers to questions
A through H and any other relevant information (Attachment 3)
bull A blank copy of the current admission application ie the information requested when the student first seeks
admission (Attachment 4) and
bullA blank copy of the current enrollment form(s) ie the information required once an applicant has been offered
admission and is registering for enrollment (Attachment 5)
Page 13
I I
i
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Section V (Continued)
Admission Policy
e school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be con led
Approximate Date of Lottery (MonthDay) ceuroSS ~ ~l-0
NA coll11lGeurolc
0ull-1lG E If the school does not utilize ottery when oversubscribed bu lleuroJSeuro~euroll-l ctole positions in the order in which
applications were received befo the expiration of the applicatil seuroeuro l 11e a first-come first-served admission process) describe the manner in ich the school notifies the ct bull 11unity of the opportunity to apply for admission TEC sect12 117 requires a charter sc of that uses ajirst-comefirst-served admission process when ove1mbscribed to publish a notice in a newspaper ofge1 ral circulation not later than the seventh day before the application deadline
Advertisements are published in the local newspap notifying the community of the Open-Enrollment Period for the school at least seven days before the close of the Ope Enrollment Period
F lfthe school has a separate process for re-enrollment state e process and the timeline to be used
he Re-Enrollment Period will begin May 4 2015 and end May 14 2 15 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 15 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the ignated window as listed above Students who could continue at their current campus but wish to transfer to a different mier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and o in a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application dea ine has passed
If an Application is received from an eligible applicant after the close of the open-enrollment p iod the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely ap ied
H Describe the infom1ation that an applicant must provide in order to be considered for admission Appi ants may not be required to provide copies of transcripts or other academic records until after they are offered od1 middotsion and are enrolling Furthermore a student may not be precluded ji-om enrolling due to the charter schools fail e to receive biformation required for enrollment ji-om the students parent or guardian or previous school See TEC sect2 002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date ofLottery (MonthDay)
0520 APPROVED DURING CONTINGENCY PROCESS
E If the school does not utilize a lottery when oversubscribed but rather fills the available positions in the order in which applications were received before the expiration ofthe application deadline (ie a first-come first-served admission process) describe the manner in which the school notifies the community of the opportunity to apply for admission TEC sect12117 requires a charter school that uses a first-come first-served admission process when oversubscribed to publish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
NIA
F If the school has a separate process for re-enrollment state the process and the timeline to be used
lfhe Re-Enrollment Period will begin May 4 2015 and end May 14 2015 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 2015 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the designated window as listed above Students who could continue at their current campus but wish to transfer to a different Premier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and obtain a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application deadline has passed
If an Application Is received from an eligible applicant after the close of the open-enrollment period the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
H Describe the information that an applicant must provide in order to be considered for admission Applicants may not be required to provide copies of transcripts or other academic records until after they are offered admission and are enrolling Furthermore a student may not be precluded from enrolling due to the charter schools failure to receive information required for enrollment from the students parent or guardian or previous school See TEC sect25002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
I The charter holder certifies that the non-discrimination statement required by TEC sectI2 I I I (a)(5) is printed in the schools admission policy TEC sect121 I I (a)(5) requires that a charter schools admission policy include a statement that the school will not discriminate in admissions based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend
0Ycs
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories ofa criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 3 7 Subchapter A as authorized by TEC sectI21 II (a)(5)(B)
0 Yes (The school excludes such students or reserves the right to exclude such students from admissions)
0 No (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bullA current copy of the admission policy that incorporates the information provided in the above answers to questions
A through H and any other relevant information (Attachment 3)
bull A blank copy of the current admission application ie the information requested when the student first seeks
admission (Attachment 4) and
bullA blank copy of the current enrollment form(s) ie the information required once an applicant has been offered
admission and is registering for enrollment (Attachment 5)
Page 13
I I
i
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Section V (Continued)
Admission Policy
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date ofLottery (MonthDay)
0520 APPROVED DURING CONTINGENCY PROCESS
E If the school does not utilize a lottery when oversubscribed but rather fills the available positions in the order in which applications were received before the expiration ofthe application deadline (ie a first-come first-served admission process) describe the manner in which the school notifies the community of the opportunity to apply for admission TEC sect12117 requires a charter school that uses a first-come first-served admission process when oversubscribed to publish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
NIA
F If the school has a separate process for re-enrollment state the process and the timeline to be used
lfhe Re-Enrollment Period will begin May 4 2015 and end May 14 2015 All forms for reenrollment will need to be received in the office of the school campus no later than 400 pm on May 14 2015 Students who wish to reenroll at their current campus should complete a re-enrollment form and return it within the designated window as listed above Students who could continue at their current campus but wish to transfer to a different Premier High School for the 2015-2016 school year should complete a re-enrollment form for their current campus and obtain a transfer form from the campus office and return it within the stated open-enrollment window
G State the procedures for processing applications received once the application deadline has passed
If an Application Is received from an eligible applicant after the close of the open-enrollment period the eligible applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
H Describe the information that an applicant must provide in order to be considered for admission Applicants may not be required to provide copies of transcripts or other academic records until after they are offered admission and are enrolling Furthermore a student may not be precluded from enrolling due to the charter schools failure to receive information required for enrollment from the students parent or guardian or previous school See TEC sect25002
A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Students can apply using one of three methods They can complete an online Application call 1-877-737-0010 or make an appointment to visit a Premier High School
Page 12
Section V (Continued)
Admission Policy
I The charter holder certifies that the non-discrimination statement required by TEC sectI2 I I I (a)(5) is printed in the schools admission policy TEC sect121 I I (a)(5) requires that a charter schools admission policy include a statement that the school will not discriminate in admissions based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend
0Ycs
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories ofa criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 3 7 Subchapter A as authorized by TEC sectI21 II (a)(5)(B)
0 Yes (The school excludes such students or reserves the right to exclude such students from admissions)
0 No (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bullA current copy of the admission policy that incorporates the information provided in the above answers to questions
A through H and any other relevant information (Attachment 3)
bull A blank copy of the current admission application ie the information requested when the student first seeks
admission (Attachment 4) and
bullA blank copy of the current enrollment form(s) ie the information required once an applicant has been offered
admission and is registering for enrollment (Attachment 5)
Page 13
I I
i
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Section V (Continued)
Admission Policy
I The charter holder certifies that the non-discrimination statement required by TEC sectI2 I I I (a)(5) is printed in the schools admission policy TEC sect121 I I (a)(5) requires that a charter schools admission policy include a statement that the school will not discriminate in admissions based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend
0Ycs
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories ofa criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 3 7 Subchapter A as authorized by TEC sectI21 II (a)(5)(B)
0 Yes (The school excludes such students or reserves the right to exclude such students from admissions)
0 No (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bullA current copy of the admission policy that incorporates the information provided in the above answers to questions
A through H and any other relevant information (Attachment 3)
bull A blank copy of the current admission application ie the information requested when the student first seeks
admission (Attachment 4) and
bullA blank copy of the current enrollment form(s) ie the information required once an applicant has been offered
admission and is registering for enrollment (Attachment 5)
Page 13
I I
i
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
I I
i
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
2014-2015 PREMIER HIGH SCHOOLS ADMISSIONS PROCESS
Enrollment of New Students
Admission and enrollment of students shall be open to any person who is eligible for admission based on lawful criteria identified in the schools charter eg qualifying residency and disciplinary history The total number of students enrolled in the school shall not exceed the number of students approved in the schools charter or subsequent amendments Applications for admission shall be due by a reasonable deadline to be set each year by the school-1e the close of the open-enrollment period
Lottery
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who have applied during the designated open[inrollment period will be offered admission If there are more eligible applicants than available spaces in a classgradeschool then a lottery will be conducted at a time set by the school each year A name [or number assigned to a name) will be drawn for each vacancy that exists and each applicant whose name (or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn
Notification of admission will be made by telephone ellinail or US Postal Service Failure of a parent to respond within 48 hours of the date of the telephone call or elilnail or within three business days of a postlilnarked letter will forfeit his or her position in the lottery Parents should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery
If a vacancy arises before the commencement of the school year the individual on the waiting list for the current year with the lowest number assignment will be offered admission and then removed from the waiting list Ifan application is received after the openlilnrollment period has passed the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied
Exceptions
Federal guidelines permit the school to exempt from the lottery process students who are already admitted under the charter siblings of students already admitted under the charter and children of the charters founders teachers and staff
Residency Information
To be eligible for continued enrollment in the school the parent must show proof of residency at the time of enrollment Failure to comply with this requirement will result in the immediate initiation of procedures to exclude students from enrollment
Residency may be verified through observation documentation and other means including but not limited to
1 a recently paid rent receipt 2 a current lease agreement 3 the most recent tax receipt indicating home ownership 4 a current utility bill indicating the address and name of the residence occupiers
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
5 mailing addresses of the residence occupiers 6 visual inspection of the residence 7 interviews with persons with relevant information or 8 building permits issued to a parent on or before September 1st of the school year in which admission
is sought (permits will serve as evidence of residency for the school year in which admission is sought only)
Falsification of residence on an enrollment form is a criminal offense
Disciplinary History
As provided in the schools charter the school may exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Sub chapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history ofan offense listed in Section 37007(a) and (d) of the Texas Education Code As such if it is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately initiate procedures to exclude the student from admission
Student Information
Any student admitted to the school must have records such as report card andor transcript from the previous school attended to verify his or her academic standing Verification of residency and current immunization records are also required Every student enrolling in the school for the first time must present documentation of immunizations as required by the Texas Department ofState Health Services
No later than 30 days after enrolling in the school the parent and school district in which the student was previously enrolled shall furnish records which verify the identity of the student These records may include the students birth certificate or a copy of the students school records from the most recently attended school
The school forwards a students records on request to a school in which a student seeks or intends to enroll without the necessity of the parents consent
Providing False Information
A person who knowingly falsifies information on a form required for enrollment of a student in the school may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination
it is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would otherwise attend in accordance with the Texas Education Code
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
DE~PC)JSI rcClllf _JL_j l_laquo i__J111
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
I
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
(Please carefully readAdmissions Process before completing)
School for Which Student Is Reglstertng (Name and City
I I
Students Legal Name (Last Fir 2015-2016 Grade Entertng
Students Primary Residence (Street me Building andor Apt City State ZIP)
Students Primary Phone Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 Scho~School Name City State)
Does the student have a documented history of a criminal o~e juvenile court adjudication or disciplinary problems Yes No
IfYes please explain
~
PRIMARY CONTACT ParentGuardian with Whom the Student Lives DO~DDYYYY) Relationship to Student
ParentGuardians E-mail address ParentGns preferred phone number
I I FathersGuardians Name (Last First Middle)
FathersGuardians Prtmary Residence ( Same As Students Address]
FathersGuardians Prtmary Phone FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle) DOB (MMDDYYYY)
MothersGuardians Prtmary Residence ( Same As Students Address]
MothersGuardians Prtmary Phone MothersGuardians E-mail Check One Home Work Cell
PARENTGUARDIAN SIGNATURE I certify that the Information contained In this Application Is true and correct Date
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
APPROVED DURING CONTINGENCY PROCESS RESPONSIVEE
2015-2016 PREMIER HIGH SCHOOL APPLICATION FOR ADMISSION
[Please carefully read Admissions Process before completing)
INSTRUCTIONS The Student Application for Admission (Application] should be completed by the students parentguardian Please print all answers legibly Ifa field does not apply please write NA Failure to provide information on this Application sufficient to permit the school to offer admission based on qualifying residency and disciplinary history will require a conference with a school representative to obtain additional information
GENERAL INFORMATION School for Which Student is Registering (Name and City)
STUDENT INFORMATION Students Legal Name (Last First Middle) Students DOB 2015-2016 Grade Entering
(MMDDYYYY)
Students Primary Residence (Street Name Building andor Apt City State ZIP)
Students Pri Students E-mail Check One Home Work Cell
School Student Attended During the 2014-2015 School Year (School Name City State]
Does the student have a documented history of a criminal offense juvenile court adjudication or disciplinary problems Yes No lfYes please explain
PRIMARY CONTACT ParentGuardian with Whom the Student Lives Relationship to Student
ParentGuardians E-mail address ParentGuardians preferred phone number
PARENT GUARDIAN INFORMATION FathersGuardians Name (Last First Middle)
FathersGuardians Primary Residence ( Same As Students Address)
FathersGua middot - r FathersGuardians E-mail Check One Home Work Cell
MothersGuardians Name (Last First Middle)
MothersGuardians Primary Residence ( Same As Students Address)
MothersGu MothersGuardians E-mail Check One Home Work Cell
PARENT GUARDIAN SIGNATURE I certify that the information contained in this Application is true and correct Date
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
SCHOOL USE ONLY Date and Time of Receipt Name ofSchool Official shy
Admission If space Is available en an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available an eligible applicant will be added to the waiting list In the order In which his or her Application was received If a vacancy arises the eligible pllcant on the waiting list with the lowest number assignment will be offered admission and then removed from the waJdng list
Applications Received After the Open-Enroll t Period If an Application Is received from an Eligible Applicant after the close of the Openmiddot Enrollment Period the Eligible Applicants name wi be added to the waiting list behind the names of the Eligible Applicants who timely applied
Reapply Students still on the waiting list on May 2 2016 who to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment P odj BECAUSE AVAlABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WILL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS AR RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT P IODAS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency lnfonnation The school may accept only those students within the sc ols designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet allure to comply with this requirement will result In the immediate Initiation of procedures to exclude the student from admission
Disciplinary History As provided In the schools charter the school lllil) exclude a stude t from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chap r 37 of the Texas Education Code The school~ exclude a student from admission who has a documented history of an offense listed In Section 007(a) [d] or [e) of the Texas Education Code As such If It Is later discovered that the student failed to disclose a documented history of a Ina) offense juvenile court adjudication or disqualifying discipline problems the school will Immediately Initiate procedures to exclude the stude from admission
Parental Rights The completion of this Application does not determine the parental relationship and d s not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty o offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter It ls the policy of the scho to prohibit dlscrtmlnatlon In student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic lllty or the district the student would otherwise attend
Premier High School Application for Admission - U ated November 20 2014
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
GENERA INFORMATION
Apply A student applying for admission to a Premier High School must complete a Student Application for Admission (Application) Applications for the 2015-2016 school year are accepted May 4 2015 through May 18 2015 (Open-Enrollment Period) Applications received after the OpenshyEnrollment Period will be handled In the order they were received Students can apply using one of three methods
1 Complete an online Application 2 Call 1-877-737-0010 or 3 Make an appointment to visit a Premier High School
Admission If space is available then an eligible applicant-Le a student with qualifying residency and disciplinary history-will be offered admission
Waiting List If space Is not available then an eligible applicant will be added to the waiting list In the order In which his or her Application was received ifa vacancy arises the eligible applicant on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list
Lottery if the number ofEligible Applicants does not exceed the number of vacancies then all Eligible Applicants who have timely applied during the open-enrollment period will be offered admission If there are more Eligible Applicants than available spaces In a classgradeschool then a lottery will be necessary In the case of a lottery you will be notified via primary contacts e-mail address of the date time and location A name (or number assigned to a name) will be drawn for each vacancy that exists and each Eligible App II cant whose name [or number) is drawn will be offered admission The remaining names will then be drawn and placed on a waiting list In the order In which they were drawn
Applications Received After the Open-Enrollment Period if an Application is received from an Eligible Applicant after the close of the OpenshyEnrollment Period the Eligible Applicants name will be added to the waiting list behind the names of the Eligible Applicants who timely applied
Enrollment Students offered admission to the school-as well as the first ten Ellgible Appllcants on the waiting lst-will be required to complete the schools Student Enrollment Packet (Enrollment Packet) STUDENTS WHO FAIL TO COMPLETE THE ENROLLMENT PACKET CALONG WITH ALL REQUIRED DOC IMENTATION) WITHIN 30 DAYS OF RECEIYING THE ENROLLMENT PACKET WILL BE DEEMED TO HAYE WITHDRAWN FROM THE SCHOO (OR WITHDRAWN THEIR APPLICATION) TO MAKE ROOM FOR OTHER ELIGIBLE APPLICANTS
Reapply Students stlll on the waiting list on May 2 2016 who wish to apply for admission for the 2016-2017 school year will need to reapply for admission May 2 2016 through May 16 2016 (Open-Enrollment Period) BECAUSE AVAILABLE POSITIONS FOR THE 2016-2017 SCHOOL YEAR WlLL BE FILLED IN THE ORDER IN WHICH THE APPLICATIONS ARE RECEIVED PRIOR TO THE CLOSE OF THE OPEN-ENROLLMENT PERIOD STUDENTS SHOULD REAPPLY AS EARLY IN THE OPEN-ENROLLMENT PERIOD AS POSSIBLE
IMPORTANT NOTIFICATIONS
Residency Information The school may accept only those students within the schools designated geographic boundary As such students will be required to show proof of residency when completing the Registration Packet Failure to comply with this requirement will result In the immediate initiation of procedures to exclude the student from admission
Disclpllnary History As provided In the schools charter the school JlliU exclude a student from admission who has a documented history of a criminal offense juvenile court adjudication or discipline problems under Subchapter A Chapter 37 of the Texas Education Code The school shall exclude a student from admission who has a documented history of an offense listed In Sectlon 37007(a) [d) or (e) of the Texas Education Code As such If it Is later discovered that the student failed to disclose a documented history of a criminal offense juvenile court adjudication or disqualifying discipline problems the school will immediately Initiate procedures to exclude the student from admission
Parental Rights The completion of this Application does not determine the parental relationship and does not affect legal right of access to the student or the students records
Providing False Information A person who knowingly falsifies Information on this Application may be guilty of an offense under Section 3710 of the Texas Penal Code
Non-Discrimination In accordance with the Texas Education Code and the schools charter it Is the policy of the school to prohibit discrimination in student admission on the basis of sex national origin ethnicity religion disability academic artistic or athletic ability or the district the student would othenvlse attend
0 remler High School Application for Admission - Updated December 192014
APPROVED DURING CONTINGENCY PROCESS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
RESPONSIVED
l I
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
RESPOIfSrVEE) RESPONSIVE TO THE COMMUNITY DESIGNED FOR THE STUDENT
Please return the f owing information with the enrollment documents to complete the
Enrollment Process
11 Completed Enrollm tApplication 11 Student Birth Certifica or Passport 11 Student Social Security C d 11 Two (2) proofs of Residency tility bill lease or rent receipts etc) 11 Current Student Immunization ecords 11 Parent or Guardians Drivers Lice se 11 Previous TAKS or STAAR records 11 At-Risk Survey 11 Copy of previous schools Report Card (1 gth grade)
11 Copy of Transcript (91h-1th grade) 11 School copy of the ParentStudent Handbook ceipt acknowledgment form
found at the back of the ParentStudent Handbo and available online at
responsiveedcom
11 Record Release
~High r1t1MIHH1tiHStH001 VJ STA CADflf(fl
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
RESPONSIVEE RESPONSIVE TO THE COMMUNITY OE SIGNED FOR THE STUDENT
2015-2016 STUDENT ENROLLMENT PACKET
Please return the following information with the enrollment documents to complete the
Enrollment Process
pRociss coNTINGENCY
D Completed Enrollment Application APPROVED oURING
D Student Birth Certificate or Passport D Student Social Security Card D Two (2) proofs of Residency (utility bill lease or rent receipts etc) D Current Student Immunization Records D Previous TAKS or STAAR records D At-Risk Survey
D Copy of previous schools Report Card (11 - gth grade)
D Copy of Transcript (91h- lzh grade) D School copy of the ParentStudent Handbook receipt acknowledgment form
found at the back of the ParentStudent Handbook and available online at
responsiveedcom
D Record Release
~High~ lIUMIERHIGH SCHOOLS VI STA ACADE1 IES1
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY)
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY) Last Grade Completed Check One a Male a Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide information regarding the school the student is zoned to attend in relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION a Fathers a Mothers a Guardians Name (Last First Middle) Living with Student
Check One a Yes a No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMfYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYYJ School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
STUDENT NAME ______________
PARENTGUARDIAN INFORMATION CONT D Fathers D Mothers D Guardlans Name (Last First Middle] Living with Student
Check One D Yes D No
Primary Residence (If Different From Students Address]
Home Phone Work Phone Cell Phone
Drivers License (No and State] E-mail
ALTERNATE CONTACT INFORMATION Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle] Relationship to Student
Home Phone Work Phone Cell Phone
Name (Last First Middle) Relationship to Student
Home Phone Work Phone Cell Phone
MILITARY DEPENDENT Are you a military dependent ~IfYes what branch Check One 0 Yes 0 No
What preschool program did your child attend Check One DABC DPrivate Preschool DEariy Childhood Special Education DPubllc School Preschool DHeadStart ONat Applicable 021 Century Community Learning Center DOther
ls this student a foster child Check One D Yes D No
ls this students family migrantseasonal workers Check One D Yes D No
LEGALALERT Is anyone legally restricted from contact with IfYes 1hen copie8 ofthe appropriate documents Student Check One D Yes 0 No (eg cOurl order etc) must be on file m1h the School
2015-2016 STUDENT ENROLLMENT PACKET PAGE2 OF12
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
STUDENT NAME _____________
EMERGENCY CARE CONSENT FORM Emergency Contacts Name [Last First Middle] Relationship to Student Note Emergency Contact should be someone other than Students ParentGuardian
Emergency Contacts Home Emergency Contacts Work Phone Emergency Contacts Cell Phone Phone
Physicians Name (Last First Middle) Physicians Work Phone
Is Student allergic to any medications Check One Q Yes QNo
IfYes please explain
In case the seVlces of a physician areteqllrecl before a parentguardian can be reached School officials areherebyautliorlZedtO take -vhatiVer actionls ffoemecl riecessaryforthehealth ofnychild I aISo middot authorize School offiCials to directly contact the physician named above lri case ofan emergency I will not
hodthe S~rigl 0flts stafffesponsilll~for el)iergemY care-1cfor ti-ansportatlltnfor my child and I will assume fttll re5p6nsibilltyfor any costs ielateatosuch servtcesprorideil t6mychlld middot middot
middot middot
ParentGtiardlanSignaturemiddot middot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE3 OF12
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
STUDENT NAME ______________
AFFIDAVIT OF STUDENT RESIDENCY Student Name (Last First Middle)
Students Residence (Street Name Building andor Apt City State ZIP)
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Name of Individual With Whom Student Resides (Last First Middle) Relationship to Student
Verification ofResldency (Texas Education Codesect 2500l(c)) Please provide at least two (2) of the followirig dcicumentS in Paientsl(]uardians llame toshow proof ofresidency at the address Indicated In this Affidavitof Stildent Residency O RecCilty Paid Rent Receipt O Cullent Lease Agreement o Most Recent Tax Statement OCtirrent UtilityBill or 0 CullentTexas Drivers License Note DocumentS showing eIJdence ofany alteration Will llOtbe accepted
_- - --- -- - shy
bull1 certify that the Information contained Iii thlS Affidavit ofStmicrodent Residency is true and correctbull
middotParentfGuantilSignature Date _ __ ---shy- ___- shy
VOLUNTARY PHOTOVIDEO RELEASE bull1 theUitderSgned do her~bygive or grant permission to and assign all rights in and to any photographs motion pictures video fciolage andor audio recorilmgs that maybe taken ofmy child during hlsfher aftelldance attheScbciol thatmay be used for promotional ortraining purposes I hereby authorize Responsive Education Solutia~ to reproduce copy exhibit publish and distribute any and all photographs motion j)lcturesvldeo footigeandor audio recordings for the sole purpose ofpromoting the School learning system andor the training and professional development ofstaff I certify that 1am overtheageofmgtenty-one (21)lunderstlindthatSignlngtblsVoluntaryPhotofVldeoReleilselsNOT acondltionofenrollinent middot middot
Date Parent(GuardianSignature
2015-2016 STUDENT ENROLLMENT PACKET PAGE40F12
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
NOTICE OF COMPULSORY ATTENDANCE LAW This notice is to advise you that according to Section 25085 of the Texas Education Code children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25086 A child who is required to attend school under this section shall attend school each day for the entire period the program ofInstruction is provided The Jaw places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly Any parent or person failing to require his child to attend school as required by law may be subject to a fine-an offense under this section is a Class C Misdemeanor and is punishable by a fine of up to $500 for each offense Section 25095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a six-month period or three (3) or more days or parts of days during a fourshyweek period The School will enforce these laws as stated by the Education Code and will report all offenses to the local authorities 8 si n below I am acknowled n the recei t of this notification J acknowledge that lhave received the Notice of ConipuJsoiy Attendance Law middot
ParentGuardlanSlgnaiure bullmiddotmiddot Date
DISCIPLINARY HISTORY Does Student have a documented historyof a criminal offense a juvenile court adjudicationor dlscipllnaty problems Check One IJ Yes IJ No lfYes please explain
OCCUPATIONAL SURVEY Within the past three (3) years has your child[ren] traveled or moved alone with a parent relative guardian or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment Check One IJ Yes IJ No
lfYes then please check the type of employment IJ Farming IJ Tree growing or harvesting IJ Ranching IJ Food processing in plants IJ Fencing IJ Plant nursery IJ Dairying IJ Poultry production IJ Fishing IJ Clearing land IJ Picking fruit or vegetables IJ Picking pecans etc Cl Cotton farmingginning IJ Bailing hay IJ Combiningharvesting grain IJ Other similar work IJ Driving tractors machinery
2015-2016 STUDENT ENROLLMENT PACKET PAGES OF12
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
STUDENT NAME ______________
2015-2016 STUDENT ENROLLMENT PACKET
(Please Print)
GENERAL INFORMATION Students Legal Name (Last First Middle) Application Date (MMDDYYYY
Primary Residence (Street Name Building andor Apt City State ZIP)
Home Phone Cell Phone Social Security No (000-00-0000)
Gender DOB (MMDDYYYY Last Grade Completed Check One D Male D Female
SCHOOL INFORMATION School District in Which the Student Resides (School Name and ISO Name) Note Please provide Information regarding the school the student is zoned to attend In relation to current residence and current grade level
Last School Student Attended (School Name City State School Year)
PRIMARY CONTACT INFORMATION D Fathers D Mothers D Guardians Name (Last First Middle) Living with Student
Check One D Yes 0 No
Primary Residence (If Different From Students Address)
Home Phone Work Phone Cell Phone
Drivers License (No and State) E-mail
FOR ADMINISTRATIVE USE ONLY Date and Time Application Received School Officials Signature (DDMMYYYY - 0000 AMPM)
Official Enrollment Date (DDMMYYYY) School Officials Signature
Official Withdrawal Date (DDMMYYYY) School Officials Signature
2015-2016 STUDENT ENROLLMENT PACKET PAGE 1OF12
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
STUDENT NAME _____________
STUDENT HEALTH HISTORY
Name ____________________Age ____Birthdate ____
Address Phone Number------ shy
History
Were there any issues during pregnancy labor andor delivery for this child Cl Yes Cl No Does this child have an ongoing health concern (asthma diabetes etc) Cl Yes Cl No
lfYes please describe---------------------- shyDoes this child have any allergies Cl Yes Cl No
ifYes please list Has the allergy required emergency treatment Cl Yes Cl No lfYes please explain ---------------------- shy
Is there a history of any hospitalizations significant injuries or surgery Cl Yes Cl No IfYes please describe ---------------------- shy
Are there any current medical concernsinjuries Cl Yes Cl No
lIAsthma or Lung Problems lIHead Injury Cl DepressionMental Health Issue Cl Heart Problems lIOlabetesHepatitis Cl Kidney Urinary Problems Cl EarNoseThroat Cl UlcersDigestive lIEpllepsySeizures ClSkinToes lIFractureDislocationStrain ClSurgery Cl Hearing AidOrthopedic Braces lIOther eg AOHD AiDS etc
Is the student pregnant Cl Yes Cl No Expected due date __________
For each condition checked above please indicate if it is past or present condition the treating physicians name and phone number and current medication requirements and purpose ________
Does this child take any medication regularly at home Cl Yes Cl No Requires medication at school Cl Yes Cl No lfYes please describe ---------------------- shy
NOTE Medication will notbeadministered to studentatschool exceptas provided for In schools MedlcatlonPollcieswhlchmaybefoundintheParent(StudentHandbook
Who lives with the child in hisher primary household-------------- shyDoes child spend a significant amount of time in another household Cl Yes Cl No lfYes please describe ---------------------- shyWho has legal custody of this child ___________________
Describe any custody arrangements------------------ shy
Any additional concerns or pertinent information (use back as needed)
Parent(GuanuaDSlgnature Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE6 OF12
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
SPECIAL EDUCATION Was Student receiving Special Education services at the last school Student attended Check One 11 Yes 11 No
lfYes then please complete the following
Check all that apply 11 Content Mastery Resource Room 11 Counseling 11 Speech Therapy 11 OccupationalPhysical Therapy CJ Behavior Adjustment Class 11 Other (Please specify
What Is Students disability middot
If No then please complete the following
Has Student ever received Special Educatim services Check One CJ Yes 11 No
IfYes please specify school name year and disabilitycondition (ifknown)
ParentGuardian Signature Date
2015-2016 STUDENT ENROLLMElff PACKET PAGE7 OF12
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
STUDENT NAME _____________
SECTION 504 Was Student receiving Sectlon504andorDyslexla servicesaccommodations at the last school Student attended Check One 0 Yes 0 No
If Yes then please complete the following
Check all that apply 0 Instructional Services 0 Instructional Accommodations 0 Testing Assessment Accommodations 0 Other (Please Specify)
What Is Students disability
If No then please complete the following
Has Student ever received Section 504 andor Dyslexia services Check One 0 Yes 0 No
lfYes please specify school name year and disabilitycondition (if known)
ParentGuardian Signaturemiddot Date
2015-2016 STUDENT ENROLLMENT PACKET PAGE80F12
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
2015-2016 HOME LANGUAGE SURVEY CUESTIONARIO DEL IDIOMA EN EL HOGAR In what month and year did the student first enroll In a school In the United States [MMYYYY)
In what city state and country was the student born
What language Is spoken In your home most of the time
What language does the student speak most of the time
Does the parent or guardian need to communicate with the school In a language other than English Check One a Yes a No lfYeswritethenameofthelanguage
middot --- shy
ParentGuardianSignature middot
LED que mes y afio se nscrb6 el estudiante por prlmera vez en Los Estados Unldos (MesAdo)
LEn que cludad estado y pals nacl6 el estudlante
LCwll es el idloma que mas se habla en su casa
LCwll es el ldioma que mas habla el estudiante
Necesltara el padre la madre o el guardian comunlcarse con la escuela utilizando un idloma que no sea el Ingles a Si a No Si es asf favor escriblr el nombre del idloma
Date
ESL PARENTGUARDIAN PERMISSION I the underslgn~d do hereby give pennlsslon for my chlld to receive extra help In English as a Second Languiige as p~rt ofa School Engllshasa Second Language (ESL) program lflieshe ls found to be limited In either oral or cognitive andacideitilc English proficiency skills lfanylanguage other than English ls spoken athome th~ SchllolWin evaluate my stiidents oral Erigllsh language skills With a short Oral Language Proficiency Test and hlsfher academic arid cognitive English With a Norm-Referenced test of LanguageArtS arid Reading skills as required by TeXa5 State Law
ParentGuarillanSignatule bull middot
2015-2016 STUDENT ENROLLMENT PACKET PAGE90F12
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
STUDENT NAME ______________
TEXAS PUBLIC SCHOOL STUDENTSTAFF ETHNICITY AND RACE DATA QUESTIONNAIRE The United States DepartmentofEducation (USDE] requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity ls the person HispanicLatino (Choose only one) IJ HispanicLatino -A person of Cuban Mexican Puerto Rican South or Central American or other
Spanish culture or origin regardless of race IJ Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more) IJ American Indian or Alaska Native-A person having origins in any of the original peoples of North
and South America (including Central America and who maintains a tribal affiliation or community attachment
IJ Asian -A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Phillpplne Islands Thailand and Vietnam
IJ Black or African American -A person having origins in any of the black racial groups ofAfrica IJ Native Hawaiian or Other Pacific Islander -A person having origins in any of the original peoples of
Hawaii Guam Samoa or other Pacific Islands IJ White -A person having origins in any of the original peoples of Europe the Middle East or North
Africa
ParentjGuardlanSlgnature middot Date
FORADMINISTRATIVE USE ONLY Ethnicity (Choose only one) Observer Signature
IJ HispanicLatino IJ Not HispanicLatino
Race (Choose one or more) IJ American Indian or Alaska Native Q Asian Date IJ Black or African American Q Native Hawaiian or Other Pacific Islander Q White
2015-2016 STUDENT ENROLLMENT PACKET PAGE 10 OF12
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
STUDENT NAME _____________
PARENTGUARDIAN SIGNATURE NOTE [A] PERSON WHO KNOWINGLY FALSIFIES INFORMATION ON A FORM REQUIRED FOR ENROLLMENT OF A STUDENT IN A SCHOOL DISTRICT IS LIABLE TO THE DISTRICT IF THE STUDENT IS NOT ELIGIBLE FOR ENROLLMENT IN THE DISTRICT BUT IS ENROLLED ON THE BASIS OF THE FALSE INFORMATION THE PERSON IS UABLE FOR THE PERIOD DURING WHICH THE INELIGIBLE STUDENT IS ENROLLED FOR THE GREATER OF (lTHE MAXIMUM TUITION FEE THE DISTRICT MAY CHARGE UNDER SECTION 25038 OR (2) THE AMOUNT THE DISTRICT HAS BUDGETED FOR EACH STUDENT AS MAINTENANCE AND OPERATING EXPENSES TEXAS EDUCATION CODEsect2S001(h)
bull1 certify that the information contained htthls Student EnrollmentAppllcatlonJs true and correct
ParentGuardianSignature Date
The School does not discriminate on the basis of sex national origin ethnlcity religion disability academic artistic or athletic ability or the district the child would otherwise attend We reserve the right to deny admission to a student who has a documented history of a criminal offense a juvenile court adjudication or disciplinary problems under Subchapter A Chapter 37 Texas Education Code
Updated November 20 2014
2015-2016 STUDENT ENROLLMENT PACKET PAGE 11oF12
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
1lfJ ~bullrtllr FOUNDERS
STUDENT RECORD RELEASE
To Releasing School Counselor or Registrar
School Name
School Address
City State Zip
School Telephone
Fax Number
The following student has withdrawn from your school
Student Name Date of Birth Student ID
Please forward the following information on the above student
_OffJCial Transcript
_Testing ScoresAssessment
_Special Education ClassificationDocuments
_Copy of Birth Certificate
_Copy of Social Security Card
_Academic Records
_Health Records
_Other
Please respond to the following address
Signature of Guardian or Registrar Date
2015-2016 STUDENT ENROLLMENT PACKET Page 12of12
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Section VI
Special Education Assurances
The charter holder certifies it has policies and procedures in place that ensure implementation of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to students with disabilities and further certifies any future amendments to the laws regulations and rules will be incorporated and implemented
Signature ofCharter Holder Board Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 14
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Section VII
Serving Students at Residential Facilities Assurances
If the charter school is currently approved to serve students at residential facilities do not provide a signature and indicate Ni A on the signature line
If operating a charter school campus on the site of a residential facility (RF) or serving students residing in or receiving services from an RF the charter holder chair certifies by signing the assurance that
Complia11ce with Special Educatio11 Requiremellfs The charter holder assures that it will comply with all of the requirements for the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act as amended the Texas Education Code and federal and state special education regulations The charter holder acknowledges that state and federal special education requirements require among other things it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FAPE to students with disabilities which may require it to contract with outside service providers or another local educational agency to provide necessary services and supports to students with disabilities
Geograpltic Bo1111daries The charter holder assures that it will accept students who reside in the school district(s) that are within each campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissio11s Criteria The charter holder assures that its admissions criteria will not be based on the presence or the absence of a disability or on gender national origin ethnicity religion academic artistic or athletic ability or the home district the child would otherwise attend
School Choice The charter holder assures that parentslegal guardians (or adult students) will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency (TEA) an external auditor or another entity
Reside11tial Facilities Mo11itori11g (RFM) System The charter holder assures that it understands that pursuant to 19 (TAC) sect97072 there is a specific system for monitoring school districts and charter schools serving students with disabilities who reside in RFs The charter holder further assures that it understands it will be required to report data related to students with disabilities residing in RFs in TEAs data collection system known as RF Tracker and it may be subject to RFM intervention activities and on-site visits based upon a review of the data reported on a random selection or other means ofselection
Trai11i11g The charter holder assures that all personnel involved with serving students with disabilities residing in a RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system Please contact your regional Educational Service Center for information regarding the required RFM system training
Page 15
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Section VII (Continued)
Serving Students at Residential Facilities Assurances
The charter holder assures this document has been shared with and understood by the RF board and that the RF board has acknowledged its understanding of all federal laws and regulations Texas laws State Board of Education (SBOE) and commissioner of education rules related to charter schools serving students at residential facilities and further certifies that any future amendments to the laws regulations and rules will be incorporated and implemented
t I
Signature ofCharter HOJd~ard Chair Date (Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 16
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Section VIII
BilingualESL Section 504 and Dyslexia Assurances
Texas Education Code Chapter 29 Subchapter B TEC sect12 l 04(b)(2)(G) and 19 TAC sectsect891201-891265 require charter schools to identify limited English proficient students based on state criteria and to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses
A The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
0Ycs
0No
Section 504 of the Rehabilitation Act of 1973 29 USC sect794 prohibits discrimination on the basis of disability in any program receiving federal financial assistance A recipient that operates a public education program or activity shall provide a free appropriate public education to qualified individuals
B The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504
0Ycs
QNo
Texas Education Code sect38003 TEC sect12 l 04(b)(2)(K) 19 TAC sect7428 and Section 504 of the Rehabilitation Act of 1973 29 US C sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
0Ycs
0No
l further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
_jL1Aln _ L ~uub Signature ofCharter Holder Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name of Charter Holder Board Chair
Page 17
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Section IX
Fingerprinting and Criminal Record Check Assurance
The charter holder certifies it is in compliance with TEC sect12120 and confirms that no individual is serving in any capacity if he or she has been convicted of a misdemeanor involving moral turpitude a felony an offense listed in TEC sect37007(a) or an offense listed in Article 62001(5) Code ofCriminal Procedures unless the individual is eligible to be employed in a position in a school district under TEC sect12120 (a-1)
Additionally the charter holder confirms all current fingerprinting and criminal record checks arc available for all employees including contract employees volunteers who indicated in writing their intention to serve board members and officers of the charter holder who arc not on the board in compliance with TEC sectsect121059 220832-220835
I 7Signature ofCharter Holde Board Chair Date
(Must sign in blue ink)
Marvin Reynolds
Printed Name ofCharter Holder Board Chair
Page 18
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Section X
Certificate of Acknowledgement
This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized during an open meeting submission of the application to the commissioner ofeducation for consideration of renewal of the charter
CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder hereby acknowledge that they have had an opportunity to review the completed renewal application and have authorized its submission during an open meeting to the commissioner ofeducation for consideration of the renewal of the charter
Typed Name Signature(Type name next to corresponding signature) Date
(Must sign in blue ink)
Marvin Reynolds
lsen Klingenstein
loaniel Maddalena
lcharles Cook
r I1
I I
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must reflect the date ofthe meeting
Page I 9
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Michael Williams Commissioner ofEducation
Lizzette C Gonzalez Reynolds Chief Deputy Commissioner
Michael Berry Deputy Commissioner Policy and Programs
Sally Partridge Associate Commissioner Accreditation and School Improvement
Heather Mauze Director Division of Charter School Administration
For further information contact the Division of Charter School Administration at
Texas Education Agency 1701 North Congress Avenue
Austin Texas 78701
(512) 463-9575 (512) 463-9732 fax
Email- ChartcrSchools(a)tcastatctxus
Or visit the website
httpteatexasgoviTexas SchoolsCharter SchoolsCharter Schools
Page 20
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Texas Education Agency
~-- Michael Williams r
CommissionerCharter Renewal Contract
February 2 2015 shyMr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS PO Box 292730 Lewisville TX 75029
Re Charter Renewal Contract for PREMIER HIGH SCHOOLS (CDN 072801)
Dear Mr Reynolds
I am pleased to inform you that the charter renewal is approved for PREMIER HIGH SCHOOLS with a contract ending date of July 31 2025 After renewal the charter contract shall consist of the following
bull the representations and assurances made by the charter holder in the original request for application under the standard application system including all revisions made during the contingency process
bull the original contract for charter as signed by the charter holder and the State Board of Education
bull any condition amendment modification revision or other change to the charter approved by the State Board of Education or the commissioner of education including any prior renewal documents with revisions based on contingency responses
bull the final renewal application received in spring 2015 on file with the Division of Charter School Administration including any revisions required by the agency and any amendments to the charter made through the renewal application and
bull all statements assurances commitments and representations made by the charter holder in its application for charter renewal and its attachments or related documents to the extent that these documents are consistent with those listed above
By accepting these renewal terms the charter holder represents that ii understands that the charter holder including any and all governance at whatever level whether appointed or elected employees agents and volunteers shall fully cooperate with every Texas Education Agency investigation andor sanction deemed necessary by the commissioner based on authority and responsibility given to the commissioner in state or federal law This means that Texas Education Agency staff may conduct confidential interviews of charter school personnel and contractors outside the presence of representatives of the charter schools administration and board and that failure to timely reply with reasonable requests for access to site personnel documents or other materials andor items is a material violation of the contract for charter
By accepting these renewal terms the charter holder represents that it is understood by all parties that if the charter holder loses its 501 (c)(3) tax exempt status for any period of time through action of the Internal Revenue Service or any other action which renders the charter holder no
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
If - - -- -~ - __rir-~~-middot~~-~middot -middotmiddot-middotmiddot-middot~~ bullr _+ ti~Jgt~AlCOI ~- t~--Sincerely
bull bull ~
Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS
Mr Marvin Reynolds Board Chair RESPONSIVE EDUCATION SOLUTIONS Page2
longer an eligible entity within the meaning of TEC sect12101a) the charter contract shall be rendered void and it shall automatically return to the Texas Education Agency without any other action having to be taken by the commissioner
Note that this contract is contingent upon legislative authorization and that the contract and the funding under state and federal law may be modified or even terminated by future legislative acts Furthermore state and federal laws and rules may periodically be adopted amended or repealed and all such changes applicable to the charter holder or its charter school(s) may modify this contract as of the effective date provided in the law or rule Nothing in the charter contract shall be construed to entitle the charter holder to any privilege or benefit including any funding but in accordance with state and federal laws in effect and as they may in the future be amended A contract term that conflicts with any state or federal law or rule is superseded by the law or rule to the extent that the law or rule conflicts with the contract term
Notwithstanding the granting of this renewal it is understood by the parties that the charter continues to be subject to future actions by the commissioner including but not limited to possible revocation underTEC 12115(c)
To acknowledge acceptance of this renewed contract the chair of the charter holder board must sign below and return the entire original document to
Texas Education Agency Division of Charter School Administration
William B Travis Building Room 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of the document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
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Michael wmiddot ms Commissmiddot ner of Education
MWbs
cc Mr Charles Cook Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for PREMIER HIGH SCHOOLS as outlined in the foregoing letter and has authorized me to sign below
Agreed and Accepted 2 tI~ ( _ tMcel o~t~r~I
Mr Marvin Reynolds DateBoard Chair RESPONSIVE EDUCATION SOLUTIONS