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OPEN-ENROLLMENT CHARTER CONTRACT RENEWAL APPLICATION
Section I Current Information in Charter School Tracking System
Charter Holder Name PINEYWOODS COMMUNITY ACADEMY
Charter School Name PINEYWOODS COMMUNITY ACADEMY
Charter School CountyDistrict 003-801
Generation 03
Maximum Approved Enrollment 750
Grades Approved PK4K123456789101112
Campuses
003801001 003801103
PINEYWOODS COMMUNITY ACADEMY HIGH SCHOOL PINEYWOODS COMMUNITY ACADEMY ELEMENTARY
602 S Raguet 602 S Raguet
Lufkin TX 75904 Lufkin TX 75904 Grade Levels Currently Served Grade Levels Currently Served
070809101112 PKKG010203040506
Geographical Boundary
The original charter application and amendment history reflects that the following district(s) comprise the charter schools geographic
boundary
ALTO ISD
APPLE SPRINGS ISD
BROADDUS ISD
CENTRAL ISD
COLMESNEIL ISD
CORRIGAN-CAMDEN ISD
D1BOLL ISD
ETOILE ISD
HUDSON ISD
HUNTINGTON ISD
LUFKIN ISD
NACOGDOCHES ISD
PALESTINE ISD
WELLS ISD
WODEN ISD
ZAVALLA ISD
1162013
Rpt_Detail Page I of5T E X A S E D U C A T I O N A G E N C Y
CHARTER DETAIL INFORMATION 91007AM
PINEYWOODS COMMUNITY ACADEMY
003801
CHARTER INFORMATION
Generation Date Approved By SBOE Type of Charter Approved Grade Levels Superintendent Name
03 09111998 Open enrollment charter Prekindergarten 4 MR BRUCE
Kindergarten MARCHANDESC Region Effective Date Type of School Grade I
07 10011998 Start-up Grade 2
Grade 3Number of Approved SitesI Projected Start Date Maximum Enrollment
1 Grade 4 08011999 750
Grade 5
Contract End Date Grade 6 RECEIVED APR B 2Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
07312013
BOARD MEMBER INFORMATION
Name Job Title Mailing Address Phone Alt Phone GVN Year
MR JOE DOUGLAS III Vice-president 905 Rushwood Drive (936) 632-6322 (936) 676-7407 2012
Lufkin TX 75904
MR CHARLIE E Secretary 6 Colonial Court (936) 637-7608 (936) 676-6514 2012
GRUMBLES Lufkin TX 75901
MR ROBERT L Member 705 OQuinn (936) 634-9746 (936) 676-0718 2012
KUYKENDALL Lufkin TX 75904
MS LOUISE M LAVANE Member 1314 Lakeview (936) 632-3090 (936)414-2509 2012
Lufkin TX 75904
DR JENNINGS N Treasurer PO Box 1743 (936) 634-7979 (936) 634-3213 2012
NARANJO Lufkin TX 75902
MS LINDA C ROBBINS Member 406 Crown Colony Drive (936) 639-3054 (936) 699-2174 2012
Lufkin TX 75904
DR SARAH ESTRINDEN President 1402 Mulberry Court (936)637-1147 (936)414-2643 2012
Lufkin TX 75904
CHARTER HOLDER INFORMATION
Charter Holder Address Name of Board President
PINEYWOODS COMMUNITY ACADEMY 602 S Raguet DR SARAH E STR1NDEN
Lufkin TX 75904
Type of Charter Holder Charter School Structure Phone Number
50I-C3 ONE CHARTER ONE SITE (936) 634-5515
Tax ID Secondary Board
752749494
MANAGEMENT INFORMATION NA
STATUS INFORMATION
Status
ACTIVE
RENEWAL APPROVED ON 5132004
Update to Data Provided by TEA
Current Members whose job titles have changed
Mr Joe Douglas III
Previous Job Title - Vice- President
Current Job Title-Member
Ms Louise LaVane
Previous Job Title -Member
Current Job Title -Treasurer
Dr Jennings N Naranjo
Previous Job Title - Treasurer
Current Job Title - President
Ms Linda C Robbins
Previous Job Title -Member
Current Job Title - Vice President
Board member who has resigned from active service
Dr Sarah Strinden
Previous Job Title - President
Current Job Title - No longer activeBoard Member Emeritus
Resigned from active service on the board January 9 2013
New Member
Dr Josefa Santiago
1407 Indigo Ct
Lufkin Texas 75904
Phone-936-635-6324
Alt Phone-936-632-9277
Previous Job Title - None
Current Job Title -Member
Joined the board January 9 2013
Board members with no change in job title
Mr Charlie E Grumbles- Secretary
Mr Robert L Kuykendall - Member
1162013
Rpt_Detail
91007AM
APPROVED DISTRICTS
District Names
PALESTINE ISD
HUDSON ISD
LUFKIN ISD
HUNTINGTON ISD
DIBOLL ISD
ZAVALLA ISD
CENTRAL ISD
ALTO ISD
WELLS ISD
NACOGDOCHES ISD
WODEN ISD
ETOILE ISD
CORRIGAN-CAMDEN ISD
BROADDUS ISD
APPLE SPRINGS ISD
COLMESNEIL ISD
ACTION INFORMATION
Type of Amendment
BOARD RELATED
BOARD RELATED
OTHER
ADDRESS CHANGEmdashPHYSICAL
BOARD RELATED
GEOGRAPHIC BOUNDARY - ADD
OTHER
RENEWAL
ADDRESS CHANGEmdashPHYSICAL
OTHER
GRADE LEVEL CHANGE
T E X A S E D U C A T I O N A G E N C Y
CHARTER DETAIL INFORMATION
PINEYWOODS COMMUNITY ACADEMY
003801
County District Numbers
001907
003902
003903
003904
003905
003906
003907
037901
037909
174904
174906
174910
187904
203902
228905
229901
Approval Date Effective Date
01081999 01081999
01142000 01142000
03032000 03032000
05122000 07012000
05122000 05122000
05122000 05122000
10082002 10082002
05132004
07072005
07222005 08042005
04112008 08012008
Information
Description of Amendment
Expand its board of trustees to 7 members
HB211
Remove all references toa professional
management company from its charter and
to amend the charter to make appropriate
provisions for these functions
Change its location as of July 1 2000 to
2515 East Lulkin Avenue Lufkin 75901
Change the structureof the governance
board to follow rules for non-profit
entities to provide for the election of new
boards by existing members
Expand geographic area from Lulkin ISD
to all of Angelina county (to include
Huntington Hudson Central Zavalla and
Diboll ISDs)
Include the following statement
Admission will not be based on gender
national origin ethnicity religion
disability academic artistic orathletic
ability or the district the child would
otherwise attend
Renewal approved for a ten year term See
letter from Commissioner for specific
details
relocate campus 001 from 2515 East
Lulkin Avenue Lulkin Texas 75901 to
602 South Raguet Lulkin Texas 75904
effective August 1 2005
decrease the number ofschool days from
197 to 187 effective August 42005
add a pre-Kindergarten four year old
program to the charters approved grade
levels (K-12) effective the 2008-2009
school year
Page 2 of5
Amendment Status
Approved
Approved
Approved
Approved
Approved
Approved
Approved
Approved
Approved
Approved
Approved
1162013
Rpt_Detail
91007AM
Type of Amendment
GEOGRAPHIC BOUNDARY - ADD
OTHER
NAME CHANGE - CAMPUS
OTHER
OTHER
ENROLLMENT CHANGE
VISIT INFORMATION
NA
T E X A S E D U C A T I O N A G E N C Y
CHARTER DETAIL INFORMATION
PINEYWOODS COMMUNITY ACADEMY
003801
Approval Date Effective Date
04112008 08012008
10142008 08252008
08012009
01192010 08012009
05112010 08012010
04202011 08012011
Description of Amendment
expand the charters geographic boundary
to include Corrigan-Camden ISD
Broaddus ISD Alto ISD Nacogdoches
ISD Woden ISD Apple Springs ISD
Palestine ISD and Etoile ISD efffective
the 2008-2009 school year
split the campus as follows
pre-kindergarten through 5th grade and
6th grade through 12th grade (campus
001)efTective August 25 2008
change the name ofcampus 103 from
Pineywoods Community Academy to
Pineywoods Community Academy
Elementary effective August I 2009
change the grade configuration for campus
103 to reflect instruction to PreK-6 grades
and campus 001 to reflect instruction to
7-12 grades effective August I 2009
add the Early College High School
p r o g r a m f o r s t u d e n t s i n g r a d e s 9 - 1 2
effective August 1 2010
increase maximum enrollment from
500 to 750 effective August 1 2011
[Included impact statements for Central
Heights Chireno Cashing Douglas
Garrison and Martinsville ISD which are
NOT on charters approved list may or
may not need to expand boundaries NGG]
Page 3of 5
Amendment Status
Approved
Approved
Approved
Approved
Approved
Approved
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003801001
Rpt_Detai
91007AM
CAMPUS INFORMATION
Campus Name
PINEYWOODS COMMUNITY
ACADEMY HIGH SCHOOL
Campus Number
Main Campus
Y
Mail Address
602 S Raguet
Lufkin TX 75904
T E X A S E D U C A T I O N A G E N C Y
CHARTER DETAIL INFORMATION
IMNEYWOODS COMMUNITY ACADEMY
003801
Approved Date Current Enrollment
09111998 160
Actual Start Date Unique Population Served
08011999
Close Date
Physical Address County
602 S Raguet 003 Angelina
Lufkin TX 75904
Puge 4 of 5
Principal Name
Ms Meriiyn Session
Phone Number
(936) 634-5515
Fax Number
(936) 634-5518
Grade Levels
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Rpt_Dttiil T E X A S E D U C A T I O N A G E N C Y RnRtsof5
11621113 CHARTER DETAIL INFORMATION 91007AM
PINEYWOODS COMMUNITY ACADEMY
003801
CAMPUS INFORMATION
Campus Name Approved Date Current Enrollment Principal Name
PINEYWOODS COMMUNITY 08252008 394 Lynette Cheek
ACADEMY ELEMENTARY
Campus Number Actual Start Date Unique Population Served Phone Number
003801103 08252008 (936)634-5515
Main Campus Close Date Fax Number N
(936)634-5518
Mail Address Physical Address County Grade Levels
602 S Rnguet 602 S Raguet 003 Angelina Prekindergorten 4
Lufkin TX 75904 Lufkin TX 75904
Kindergarten
Grade I
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Update to Data Provided by TEA for
Pirieywoods Community AcademyElementary Campus 003801103
Principal Name - Bruce Marchand
Replaces Lynette Cheek
Section II Contact Information
The persons listed below will be contacted by agency staff if there are issues to be resolved in any of the sections
Superintendent Contact Information
Superintendents Name Bruce Marchand
Telephone Number 936-634-5515
Fax Number 936-634-5518
E-mail Address bmarchandpineywoodsacademyorg
Charter Holder Board Chair Contact Information
Charter Holder Board Dr Neal Naranjo
Chairs Name
Telephone Number 936-634-7979
Fax Number 936-634-7967
E-mail Address asdfnealgmailcom
Application Preparers Contact Information
Contact Name Bruce Marchand
Telephone Number 936-634-5515
Fax Number 936-634-5518
E-mail Address bmarchandpineywoodsacademyorg
Charter School Website
Web address wwwpineywoodsacademyorg
Page 7
Section III Posting of Adopted Budget
Chapter 12 of the Texas Education Code (TEC) specifically sect12104(b)(2)(E) makes explicit that open-enrollment
charters are required to comply with TEC Chapter 39 Subchapter D Financial Accountability TEC sect39084
titled Posting ofAdopted Budget states the following
(a) On final approval of the budget by the board of trustees the school district shall post on the districts Internet
website a copy of the budget adopted by the board of trustees The districts Internet website must prominently
display the electronic link to the adopted budget
(b) The district shall maintain the adopted budget on the districts Internet website until the third anniversary of the
date the budget was adopted
Provide the web address of the adopted budgets
wwwpineywoodsacademyorgaboutbudget
Page 8
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 9
Attachment1
Pineywoods Community Academy
Administrative Position Organizational Chart
Superintendent Elementary Principals
Secondary Principal (Grades 7-12 )
PARAMUS ECHS Principal (9-12)
Elementary Assistant Principal
Special Education Director
Director of Business Operations
Business Manager
Food Service Director
Technology Director
Updated March 2013
Bruce Marchand
Monica Gunter
Merilyn Session
Delbert Murphy
Keri Burton
George Fowler
Tina May
Jim McLeod
Steve Horrocks
Attachment 1A
PCA Board of DirectorsPCA Parents LufkinAngelina County Community1
PCA Executive DirectorSuperintendent]
Director of Business Operations Elem Asst Principal ECHS Principal Secondary Principal
Food Service Director Food Service Staff
Technology Director
Business Manager
Elementary REIMS Clerk
econdary REIMS Clerk
Building Manager Custodians
Elementary Teachers Sebpndary Teaches
Special Education Director
Nurse
dministrative Assistant High School Counselor
Bus Driver
structional Paraprofessionals Day Care Coordinator
School Counselor
Note 1) Director conducts performance appraisals of elementary teachers and elementary special education and intervention teachers
2) Secondary Principal conducts performance appraisals of secondary teachers and secondary special education teachers
3) Supervision and evaluation of Technology Director and PEIMS Clerks is the shared responsibility of the Director of Business Operations Director and Secondary Principal
Revised September 2012
Attachment 2
Not applicable - there are no other entities under the direction of the charter board
REVISED DURING CONTINGENCY PROCESS SEEINSERT
Section V Admission
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadlinefor the submission ofapplicationsfor admission
Beginning of Period End of Period (MonthDay) (MonthDay)
January 2 (or first day of school afterj March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013 q
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One p Yes
(bull No
C Not applicable (because lotteries are not utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
S- 3 1
V D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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 afirst-come first-served admission process when oversubscribed topublish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
Type Below
Page 10
APPROVED DURING CONTINGENCYPROCESS
Section V Admissi
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charier school establish a reasonable application deadlinefor the submission of applicationsfor admission
Beginning of Period End of Period
(MonthDay) (MonthDay)
January 2 (or first day of school afteM March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One 0Yes
No
C Not applicable (because lotteries arenot utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
Students who are currently enrolled and return the Notice of Intent to Return form prior to April Is indicating they wish tocontinue enrollment at PCA are considered enrolled and exempt from an enrollment lottery it the number of applicants exceeds the number of available seats at a grade level In addition any siblings of currently enrolled studentsare given priority in admission to fill any available slots If more than one student at a grade level on the waiting list has a sibling attending PCA a drawing will be heldbetween the eligible siblings todetermine admission
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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
regwres a cAwer scroo W uses proceM Wien overjwkcrifW to a
notice in a newspaper of general circulation not later than the seventh day before the application deadline Type Below
Page 10
F If the school has a separate process for re-enrollment state the process and the timeline to be used
Type Below
Students currently enrolled in Pineywoods Community Academy will receive a Notice of Intent to Return form in early January Parents are to notify the school in writing through the return of the form no later than the last day of January if they intend for their child to attend Pineywoods Community Academy for the next school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currentlyenrolled student without an NIR will be removed from enrollment roster on the last day of March in order to make room for new enrollees Parents who do not return an NIR will be contacted to verify that they do not intend to enroll their student in PCA for the following year
G State the procedures for processing applications received once the application deadline has passed
Type Below
Applications received after the open enrollment date will be processed based on the date received and placed after the names of students chosen by lottery whose applications were received by the open enrollment deadline
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 beprecludedfrom enrolling due to the charter schoolsfailure to receive information requiredfor enrollmentfrom the students parent or guardian orprevious school See TEC sect25002 Type Below
Applicants are required to fill out an enrollment form and must provide current immunization information a birth certificate a copy of the social security card if available and a copy of the parents drivers license Students are not required to provide copies of transcripts or other academic records and 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
I The charter holder certifies that the non-discrimination statement required by TEC sect12111(a)(6) is printed in the schools admission policy TEC sect12111(6) requires that a charter schools admission policy include astatement 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
Check One (gtYes
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories of a criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC sect 12111(a)(6) Check Oneshy
^ Yes ( The school excludes such students or reserves the right to exclude such students from admissions)
pNo (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bull as Attachment 3 a current copy of the admission policy that incorporates the information provided in the aboveahswers to questions A through H and any other relevant information
bull as Attachment 4 a blank copy of the current admission application (ie the information requested when the student first seeks admission) and
bull as Attachment 5 a blank copy of the current enrollment form(s) (ie the information required once an applicant has been offered admission and is registering for enrollment)
Page 11
Attachment 3
Admissions Policy
2013-2014 Admissions Procedure Timeline
Students currently enrolled in Pineywoods Community Academy will receive a Notice ofIntent to Return form in early January Parents are to notify the school in writing through the return of the form no later than Wednesday January 16th 2013 if they intend for their child to attend Pineywoods Community Academy for the 2013-2014 school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currently enrolled student without an NIR will be removed from the 2013-2014 enrollment roster on March 29th 2013 in order to make room for new enrollees
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted during the week of April 1st 2013
During the lottery a name is drawn for each vacancy that is available Each eligible applicants name drawn will be offered admission into Pineywoods Community Academy to fill spaces in that grade level Once available spaces are exhausted the remaining names drawn are placed on a waiting list in the order that the names are drawn PCA will begin notifying accepted applicants during the week of April 8th 2013 Students admitted into the school will be notified as well as students who are placed on a waiting list
If an additional vacancy occurs before the start of school or during the school year the student with the lowest number on the waiting list will be offered enrollment and that name will be removed from the waiting list If an application is received after the enrollment period the applicants name will be placed on the waiting list in the order the application is received In order to accommodate our families if more than one student on the waiting list has a sibling attending PCA a drawing will be held between the eligible siblings to determine admission
Pineywoods Academy does not discriminate on acceptance into the school based on gender national origin ethnicity religion disability academics artistic or athletic ability or the district the child would otherwise attend
Pineywoods Academy may choose to deny admission to students with a documented history of criminal offense juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111(a)(6)
This policy can be accessed from the PCA website at
httpwwwpineywoodsacademyorgadmissionspolicy
eiA Attachment 4 spoundf
AsSfr com
m Student Enrollment Application ypOr 1Pineywoods Community Academy Charter School
2013-2014 School Year
5WshyVS
H
DATE Completed_
Student Information
Students LegalName First Middle Last (as listed on birth certificate)
Gender malefemale Birth date (mdy)_ _ Birth City_ Birth State
Birth Country_ Grade Level for 2013-2014
Is this a repeatgrade YN
Students Street Address_
City State
County_ _Zip_ _Social Security _
Mailing Address (if different from above)
Street City_ State Zip
School District ofResidence
Past EnrollmentDetails
Previous SchoolsAttended (most recentfirst)
School Name School Name
Address Address
City_ State _Zip_ City State _Zip_
Phone _Dates of Attendance Phone _Dates of Attendance
Last Grade Completed atthis school _Last Grade Completed at this school
This school was a Check one This school was a Check one Public School Public School Private SchoolNon-religious Affiliated Private School Non-religious Affiliated Private School Religious Affiliated Private SchoolReligious Affiliated Charter School Charter School Home School Home School School outside of the Country School outsideof the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParcntGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach acopy of thecourt order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applvine to attend PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A
as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (ISS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information provided on this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsificatioti of these recordsfor anypurpose may be prosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
1162013
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CHARTER DETAIL INFORMATION 91007AM
PINEYWOODS COMMUNITY ACADEMY
003801
CHARTER INFORMATION
Generation Date Approved By SBOE Type of Charter Approved Grade Levels Superintendent Name
03 09111998 Open enrollment charter Prekindergarten 4 MR BRUCE
Kindergarten MARCHANDESC Region Effective Date Type of School Grade I
07 10011998 Start-up Grade 2
Grade 3Number of Approved SitesI Projected Start Date Maximum Enrollment
1 Grade 4 08011999 750
Grade 5
Contract End Date Grade 6 RECEIVED APR B 2Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
07312013
BOARD MEMBER INFORMATION
Name Job Title Mailing Address Phone Alt Phone GVN Year
MR JOE DOUGLAS III Vice-president 905 Rushwood Drive (936) 632-6322 (936) 676-7407 2012
Lufkin TX 75904
MR CHARLIE E Secretary 6 Colonial Court (936) 637-7608 (936) 676-6514 2012
GRUMBLES Lufkin TX 75901
MR ROBERT L Member 705 OQuinn (936) 634-9746 (936) 676-0718 2012
KUYKENDALL Lufkin TX 75904
MS LOUISE M LAVANE Member 1314 Lakeview (936) 632-3090 (936)414-2509 2012
Lufkin TX 75904
DR JENNINGS N Treasurer PO Box 1743 (936) 634-7979 (936) 634-3213 2012
NARANJO Lufkin TX 75902
MS LINDA C ROBBINS Member 406 Crown Colony Drive (936) 639-3054 (936) 699-2174 2012
Lufkin TX 75904
DR SARAH ESTRINDEN President 1402 Mulberry Court (936)637-1147 (936)414-2643 2012
Lufkin TX 75904
CHARTER HOLDER INFORMATION
Charter Holder Address Name of Board President
PINEYWOODS COMMUNITY ACADEMY 602 S Raguet DR SARAH E STR1NDEN
Lufkin TX 75904
Type of Charter Holder Charter School Structure Phone Number
50I-C3 ONE CHARTER ONE SITE (936) 634-5515
Tax ID Secondary Board
752749494
MANAGEMENT INFORMATION NA
STATUS INFORMATION
Status
ACTIVE
RENEWAL APPROVED ON 5132004
Update to Data Provided by TEA
Current Members whose job titles have changed
Mr Joe Douglas III
Previous Job Title - Vice- President
Current Job Title-Member
Ms Louise LaVane
Previous Job Title -Member
Current Job Title -Treasurer
Dr Jennings N Naranjo
Previous Job Title - Treasurer
Current Job Title - President
Ms Linda C Robbins
Previous Job Title -Member
Current Job Title - Vice President
Board member who has resigned from active service
Dr Sarah Strinden
Previous Job Title - President
Current Job Title - No longer activeBoard Member Emeritus
Resigned from active service on the board January 9 2013
New Member
Dr Josefa Santiago
1407 Indigo Ct
Lufkin Texas 75904
Phone-936-635-6324
Alt Phone-936-632-9277
Previous Job Title - None
Current Job Title -Member
Joined the board January 9 2013
Board members with no change in job title
Mr Charlie E Grumbles- Secretary
Mr Robert L Kuykendall - Member
1162013
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91007AM
APPROVED DISTRICTS
District Names
PALESTINE ISD
HUDSON ISD
LUFKIN ISD
HUNTINGTON ISD
DIBOLL ISD
ZAVALLA ISD
CENTRAL ISD
ALTO ISD
WELLS ISD
NACOGDOCHES ISD
WODEN ISD
ETOILE ISD
CORRIGAN-CAMDEN ISD
BROADDUS ISD
APPLE SPRINGS ISD
COLMESNEIL ISD
ACTION INFORMATION
Type of Amendment
BOARD RELATED
BOARD RELATED
OTHER
ADDRESS CHANGEmdashPHYSICAL
BOARD RELATED
GEOGRAPHIC BOUNDARY - ADD
OTHER
RENEWAL
ADDRESS CHANGEmdashPHYSICAL
OTHER
GRADE LEVEL CHANGE
T E X A S E D U C A T I O N A G E N C Y
CHARTER DETAIL INFORMATION
PINEYWOODS COMMUNITY ACADEMY
003801
County District Numbers
001907
003902
003903
003904
003905
003906
003907
037901
037909
174904
174906
174910
187904
203902
228905
229901
Approval Date Effective Date
01081999 01081999
01142000 01142000
03032000 03032000
05122000 07012000
05122000 05122000
05122000 05122000
10082002 10082002
05132004
07072005
07222005 08042005
04112008 08012008
Information
Description of Amendment
Expand its board of trustees to 7 members
HB211
Remove all references toa professional
management company from its charter and
to amend the charter to make appropriate
provisions for these functions
Change its location as of July 1 2000 to
2515 East Lulkin Avenue Lufkin 75901
Change the structureof the governance
board to follow rules for non-profit
entities to provide for the election of new
boards by existing members
Expand geographic area from Lulkin ISD
to all of Angelina county (to include
Huntington Hudson Central Zavalla and
Diboll ISDs)
Include the following statement
Admission will not be based on gender
national origin ethnicity religion
disability academic artistic orathletic
ability or the district the child would
otherwise attend
Renewal approved for a ten year term See
letter from Commissioner for specific
details
relocate campus 001 from 2515 East
Lulkin Avenue Lulkin Texas 75901 to
602 South Raguet Lulkin Texas 75904
effective August 1 2005
decrease the number ofschool days from
197 to 187 effective August 42005
add a pre-Kindergarten four year old
program to the charters approved grade
levels (K-12) effective the 2008-2009
school year
Page 2 of5
Amendment Status
Approved
Approved
Approved
Approved
Approved
Approved
Approved
Approved
Approved
Approved
Approved
1162013
Rpt_Detail
91007AM
Type of Amendment
GEOGRAPHIC BOUNDARY - ADD
OTHER
NAME CHANGE - CAMPUS
OTHER
OTHER
ENROLLMENT CHANGE
VISIT INFORMATION
NA
T E X A S E D U C A T I O N A G E N C Y
CHARTER DETAIL INFORMATION
PINEYWOODS COMMUNITY ACADEMY
003801
Approval Date Effective Date
04112008 08012008
10142008 08252008
08012009
01192010 08012009
05112010 08012010
04202011 08012011
Description of Amendment
expand the charters geographic boundary
to include Corrigan-Camden ISD
Broaddus ISD Alto ISD Nacogdoches
ISD Woden ISD Apple Springs ISD
Palestine ISD and Etoile ISD efffective
the 2008-2009 school year
split the campus as follows
pre-kindergarten through 5th grade and
6th grade through 12th grade (campus
001)efTective August 25 2008
change the name ofcampus 103 from
Pineywoods Community Academy to
Pineywoods Community Academy
Elementary effective August I 2009
change the grade configuration for campus
103 to reflect instruction to PreK-6 grades
and campus 001 to reflect instruction to
7-12 grades effective August I 2009
add the Early College High School
p r o g r a m f o r s t u d e n t s i n g r a d e s 9 - 1 2
effective August 1 2010
increase maximum enrollment from
500 to 750 effective August 1 2011
[Included impact statements for Central
Heights Chireno Cashing Douglas
Garrison and Martinsville ISD which are
NOT on charters approved list may or
may not need to expand boundaries NGG]
Page 3of 5
Amendment Status
Approved
Approved
Approved
Approved
Approved
Approved
1162013
003801001
Rpt_Detai
91007AM
CAMPUS INFORMATION
Campus Name
PINEYWOODS COMMUNITY
ACADEMY HIGH SCHOOL
Campus Number
Main Campus
Y
Mail Address
602 S Raguet
Lufkin TX 75904
T E X A S E D U C A T I O N A G E N C Y
CHARTER DETAIL INFORMATION
IMNEYWOODS COMMUNITY ACADEMY
003801
Approved Date Current Enrollment
09111998 160
Actual Start Date Unique Population Served
08011999
Close Date
Physical Address County
602 S Raguet 003 Angelina
Lufkin TX 75904
Puge 4 of 5
Principal Name
Ms Meriiyn Session
Phone Number
(936) 634-5515
Fax Number
(936) 634-5518
Grade Levels
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Rpt_Dttiil T E X A S E D U C A T I O N A G E N C Y RnRtsof5
11621113 CHARTER DETAIL INFORMATION 91007AM
PINEYWOODS COMMUNITY ACADEMY
003801
CAMPUS INFORMATION
Campus Name Approved Date Current Enrollment Principal Name
PINEYWOODS COMMUNITY 08252008 394 Lynette Cheek
ACADEMY ELEMENTARY
Campus Number Actual Start Date Unique Population Served Phone Number
003801103 08252008 (936)634-5515
Main Campus Close Date Fax Number N
(936)634-5518
Mail Address Physical Address County Grade Levels
602 S Rnguet 602 S Raguet 003 Angelina Prekindergorten 4
Lufkin TX 75904 Lufkin TX 75904
Kindergarten
Grade I
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Update to Data Provided by TEA for
Pirieywoods Community AcademyElementary Campus 003801103
Principal Name - Bruce Marchand
Replaces Lynette Cheek
Section II Contact Information
The persons listed below will be contacted by agency staff if there are issues to be resolved in any of the sections
Superintendent Contact Information
Superintendents Name Bruce Marchand
Telephone Number 936-634-5515
Fax Number 936-634-5518
E-mail Address bmarchandpineywoodsacademyorg
Charter Holder Board Chair Contact Information
Charter Holder Board Dr Neal Naranjo
Chairs Name
Telephone Number 936-634-7979
Fax Number 936-634-7967
E-mail Address asdfnealgmailcom
Application Preparers Contact Information
Contact Name Bruce Marchand
Telephone Number 936-634-5515
Fax Number 936-634-5518
E-mail Address bmarchandpineywoodsacademyorg
Charter School Website
Web address wwwpineywoodsacademyorg
Page 7
Section III Posting of Adopted Budget
Chapter 12 of the Texas Education Code (TEC) specifically sect12104(b)(2)(E) makes explicit that open-enrollment
charters are required to comply with TEC Chapter 39 Subchapter D Financial Accountability TEC sect39084
titled Posting ofAdopted Budget states the following
(a) On final approval of the budget by the board of trustees the school district shall post on the districts Internet
website a copy of the budget adopted by the board of trustees The districts Internet website must prominently
display the electronic link to the adopted budget
(b) The district shall maintain the adopted budget on the districts Internet website until the third anniversary of the
date the budget was adopted
Provide the web address of the adopted budgets
wwwpineywoodsacademyorgaboutbudget
Page 8
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 9
Attachment1
Pineywoods Community Academy
Administrative Position Organizational Chart
Superintendent Elementary Principals
Secondary Principal (Grades 7-12 )
PARAMUS ECHS Principal (9-12)
Elementary Assistant Principal
Special Education Director
Director of Business Operations
Business Manager
Food Service Director
Technology Director
Updated March 2013
Bruce Marchand
Monica Gunter
Merilyn Session
Delbert Murphy
Keri Burton
George Fowler
Tina May
Jim McLeod
Steve Horrocks
Attachment 1A
PCA Board of DirectorsPCA Parents LufkinAngelina County Community1
PCA Executive DirectorSuperintendent]
Director of Business Operations Elem Asst Principal ECHS Principal Secondary Principal
Food Service Director Food Service Staff
Technology Director
Business Manager
Elementary REIMS Clerk
econdary REIMS Clerk
Building Manager Custodians
Elementary Teachers Sebpndary Teaches
Special Education Director
Nurse
dministrative Assistant High School Counselor
Bus Driver
structional Paraprofessionals Day Care Coordinator
School Counselor
Note 1) Director conducts performance appraisals of elementary teachers and elementary special education and intervention teachers
2) Secondary Principal conducts performance appraisals of secondary teachers and secondary special education teachers
3) Supervision and evaluation of Technology Director and PEIMS Clerks is the shared responsibility of the Director of Business Operations Director and Secondary Principal
Revised September 2012
Attachment 2
Not applicable - there are no other entities under the direction of the charter board
REVISED DURING CONTINGENCY PROCESS SEEINSERT
Section V Admission
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadlinefor the submission ofapplicationsfor admission
Beginning of Period End of Period (MonthDay) (MonthDay)
January 2 (or first day of school afterj March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013 q
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One p Yes
(bull No
C Not applicable (because lotteries are not utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
S- 3 1
V D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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 afirst-come first-served admission process when oversubscribed topublish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
Type Below
Page 10
APPROVED DURING CONTINGENCYPROCESS
Section V Admissi
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charier school establish a reasonable application deadlinefor the submission of applicationsfor admission
Beginning of Period End of Period
(MonthDay) (MonthDay)
January 2 (or first day of school afteM March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One 0Yes
No
C Not applicable (because lotteries arenot utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
Students who are currently enrolled and return the Notice of Intent to Return form prior to April Is indicating they wish tocontinue enrollment at PCA are considered enrolled and exempt from an enrollment lottery it the number of applicants exceeds the number of available seats at a grade level In addition any siblings of currently enrolled studentsare given priority in admission to fill any available slots If more than one student at a grade level on the waiting list has a sibling attending PCA a drawing will be heldbetween the eligible siblings todetermine admission
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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
regwres a cAwer scroo W uses proceM Wien overjwkcrifW to a
notice in a newspaper of general circulation not later than the seventh day before the application deadline Type Below
Page 10
F If the school has a separate process for re-enrollment state the process and the timeline to be used
Type Below
Students currently enrolled in Pineywoods Community Academy will receive a Notice of Intent to Return form in early January Parents are to notify the school in writing through the return of the form no later than the last day of January if they intend for their child to attend Pineywoods Community Academy for the next school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currentlyenrolled student without an NIR will be removed from enrollment roster on the last day of March in order to make room for new enrollees Parents who do not return an NIR will be contacted to verify that they do not intend to enroll their student in PCA for the following year
G State the procedures for processing applications received once the application deadline has passed
Type Below
Applications received after the open enrollment date will be processed based on the date received and placed after the names of students chosen by lottery whose applications were received by the open enrollment deadline
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 beprecludedfrom enrolling due to the charter schoolsfailure to receive information requiredfor enrollmentfrom the students parent or guardian orprevious school See TEC sect25002 Type Below
Applicants are required to fill out an enrollment form and must provide current immunization information a birth certificate a copy of the social security card if available and a copy of the parents drivers license Students are not required to provide copies of transcripts or other academic records and 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
I The charter holder certifies that the non-discrimination statement required by TEC sect12111(a)(6) is printed in the schools admission policy TEC sect12111(6) requires that a charter schools admission policy include astatement 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
Check One (gtYes
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories of a criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC sect 12111(a)(6) Check Oneshy
^ Yes ( The school excludes such students or reserves the right to exclude such students from admissions)
pNo (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bull as Attachment 3 a current copy of the admission policy that incorporates the information provided in the aboveahswers to questions A through H and any other relevant information
bull as Attachment 4 a blank copy of the current admission application (ie the information requested when the student first seeks admission) and
bull as Attachment 5 a blank copy of the current enrollment form(s) (ie the information required once an applicant has been offered admission and is registering for enrollment)
Page 11
Attachment 3
Admissions Policy
2013-2014 Admissions Procedure Timeline
Students currently enrolled in Pineywoods Community Academy will receive a Notice ofIntent to Return form in early January Parents are to notify the school in writing through the return of the form no later than Wednesday January 16th 2013 if they intend for their child to attend Pineywoods Community Academy for the 2013-2014 school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currently enrolled student without an NIR will be removed from the 2013-2014 enrollment roster on March 29th 2013 in order to make room for new enrollees
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted during the week of April 1st 2013
During the lottery a name is drawn for each vacancy that is available Each eligible applicants name drawn will be offered admission into Pineywoods Community Academy to fill spaces in that grade level Once available spaces are exhausted the remaining names drawn are placed on a waiting list in the order that the names are drawn PCA will begin notifying accepted applicants during the week of April 8th 2013 Students admitted into the school will be notified as well as students who are placed on a waiting list
If an additional vacancy occurs before the start of school or during the school year the student with the lowest number on the waiting list will be offered enrollment and that name will be removed from the waiting list If an application is received after the enrollment period the applicants name will be placed on the waiting list in the order the application is received In order to accommodate our families if more than one student on the waiting list has a sibling attending PCA a drawing will be held between the eligible siblings to determine admission
Pineywoods Academy does not discriminate on acceptance into the school based on gender national origin ethnicity religion disability academics artistic or athletic ability or the district the child would otherwise attend
Pineywoods Academy may choose to deny admission to students with a documented history of criminal offense juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111(a)(6)
This policy can be accessed from the PCA website at
httpwwwpineywoodsacademyorgadmissionspolicy
eiA Attachment 4 spoundf
AsSfr com
m Student Enrollment Application ypOr 1Pineywoods Community Academy Charter School
2013-2014 School Year
5WshyVS
H
DATE Completed_
Student Information
Students LegalName First Middle Last (as listed on birth certificate)
Gender malefemale Birth date (mdy)_ _ Birth City_ Birth State
Birth Country_ Grade Level for 2013-2014
Is this a repeatgrade YN
Students Street Address_
City State
County_ _Zip_ _Social Security _
Mailing Address (if different from above)
Street City_ State Zip
School District ofResidence
Past EnrollmentDetails
Previous SchoolsAttended (most recentfirst)
School Name School Name
Address Address
City_ State _Zip_ City State _Zip_
Phone _Dates of Attendance Phone _Dates of Attendance
Last Grade Completed atthis school _Last Grade Completed at this school
This school was a Check one This school was a Check one Public School Public School Private SchoolNon-religious Affiliated Private School Non-religious Affiliated Private School Religious Affiliated Private SchoolReligious Affiliated Charter School Charter School Home School Home School School outside of the Country School outsideof the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParcntGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach acopy of thecourt order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applvine to attend PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A
as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (ISS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information provided on this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsificatioti of these recordsfor anypurpose may be prosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
Update to Data Provided by TEA
Current Members whose job titles have changed
Mr Joe Douglas III
Previous Job Title - Vice- President
Current Job Title-Member
Ms Louise LaVane
Previous Job Title -Member
Current Job Title -Treasurer
Dr Jennings N Naranjo
Previous Job Title - Treasurer
Current Job Title - President
Ms Linda C Robbins
Previous Job Title -Member
Current Job Title - Vice President
Board member who has resigned from active service
Dr Sarah Strinden
Previous Job Title - President
Current Job Title - No longer activeBoard Member Emeritus
Resigned from active service on the board January 9 2013
New Member
Dr Josefa Santiago
1407 Indigo Ct
Lufkin Texas 75904
Phone-936-635-6324
Alt Phone-936-632-9277
Previous Job Title - None
Current Job Title -Member
Joined the board January 9 2013
Board members with no change in job title
Mr Charlie E Grumbles- Secretary
Mr Robert L Kuykendall - Member
1162013
Rpt_Detail
91007AM
APPROVED DISTRICTS
District Names
PALESTINE ISD
HUDSON ISD
LUFKIN ISD
HUNTINGTON ISD
DIBOLL ISD
ZAVALLA ISD
CENTRAL ISD
ALTO ISD
WELLS ISD
NACOGDOCHES ISD
WODEN ISD
ETOILE ISD
CORRIGAN-CAMDEN ISD
BROADDUS ISD
APPLE SPRINGS ISD
COLMESNEIL ISD
ACTION INFORMATION
Type of Amendment
BOARD RELATED
BOARD RELATED
OTHER
ADDRESS CHANGEmdashPHYSICAL
BOARD RELATED
GEOGRAPHIC BOUNDARY - ADD
OTHER
RENEWAL
ADDRESS CHANGEmdashPHYSICAL
OTHER
GRADE LEVEL CHANGE
T E X A S E D U C A T I O N A G E N C Y
CHARTER DETAIL INFORMATION
PINEYWOODS COMMUNITY ACADEMY
003801
County District Numbers
001907
003902
003903
003904
003905
003906
003907
037901
037909
174904
174906
174910
187904
203902
228905
229901
Approval Date Effective Date
01081999 01081999
01142000 01142000
03032000 03032000
05122000 07012000
05122000 05122000
05122000 05122000
10082002 10082002
05132004
07072005
07222005 08042005
04112008 08012008
Information
Description of Amendment
Expand its board of trustees to 7 members
HB211
Remove all references toa professional
management company from its charter and
to amend the charter to make appropriate
provisions for these functions
Change its location as of July 1 2000 to
2515 East Lulkin Avenue Lufkin 75901
Change the structureof the governance
board to follow rules for non-profit
entities to provide for the election of new
boards by existing members
Expand geographic area from Lulkin ISD
to all of Angelina county (to include
Huntington Hudson Central Zavalla and
Diboll ISDs)
Include the following statement
Admission will not be based on gender
national origin ethnicity religion
disability academic artistic orathletic
ability or the district the child would
otherwise attend
Renewal approved for a ten year term See
letter from Commissioner for specific
details
relocate campus 001 from 2515 East
Lulkin Avenue Lulkin Texas 75901 to
602 South Raguet Lulkin Texas 75904
effective August 1 2005
decrease the number ofschool days from
197 to 187 effective August 42005
add a pre-Kindergarten four year old
program to the charters approved grade
levels (K-12) effective the 2008-2009
school year
Page 2 of5
Amendment Status
Approved
Approved
Approved
Approved
Approved
Approved
Approved
Approved
Approved
Approved
Approved
1162013
Rpt_Detail
91007AM
Type of Amendment
GEOGRAPHIC BOUNDARY - ADD
OTHER
NAME CHANGE - CAMPUS
OTHER
OTHER
ENROLLMENT CHANGE
VISIT INFORMATION
NA
T E X A S E D U C A T I O N A G E N C Y
CHARTER DETAIL INFORMATION
PINEYWOODS COMMUNITY ACADEMY
003801
Approval Date Effective Date
04112008 08012008
10142008 08252008
08012009
01192010 08012009
05112010 08012010
04202011 08012011
Description of Amendment
expand the charters geographic boundary
to include Corrigan-Camden ISD
Broaddus ISD Alto ISD Nacogdoches
ISD Woden ISD Apple Springs ISD
Palestine ISD and Etoile ISD efffective
the 2008-2009 school year
split the campus as follows
pre-kindergarten through 5th grade and
6th grade through 12th grade (campus
001)efTective August 25 2008
change the name ofcampus 103 from
Pineywoods Community Academy to
Pineywoods Community Academy
Elementary effective August I 2009
change the grade configuration for campus
103 to reflect instruction to PreK-6 grades
and campus 001 to reflect instruction to
7-12 grades effective August I 2009
add the Early College High School
p r o g r a m f o r s t u d e n t s i n g r a d e s 9 - 1 2
effective August 1 2010
increase maximum enrollment from
500 to 750 effective August 1 2011
[Included impact statements for Central
Heights Chireno Cashing Douglas
Garrison and Martinsville ISD which are
NOT on charters approved list may or
may not need to expand boundaries NGG]
Page 3of 5
Amendment Status
Approved
Approved
Approved
Approved
Approved
Approved
1162013
003801001
Rpt_Detai
91007AM
CAMPUS INFORMATION
Campus Name
PINEYWOODS COMMUNITY
ACADEMY HIGH SCHOOL
Campus Number
Main Campus
Y
Mail Address
602 S Raguet
Lufkin TX 75904
T E X A S E D U C A T I O N A G E N C Y
CHARTER DETAIL INFORMATION
IMNEYWOODS COMMUNITY ACADEMY
003801
Approved Date Current Enrollment
09111998 160
Actual Start Date Unique Population Served
08011999
Close Date
Physical Address County
602 S Raguet 003 Angelina
Lufkin TX 75904
Puge 4 of 5
Principal Name
Ms Meriiyn Session
Phone Number
(936) 634-5515
Fax Number
(936) 634-5518
Grade Levels
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Rpt_Dttiil T E X A S E D U C A T I O N A G E N C Y RnRtsof5
11621113 CHARTER DETAIL INFORMATION 91007AM
PINEYWOODS COMMUNITY ACADEMY
003801
CAMPUS INFORMATION
Campus Name Approved Date Current Enrollment Principal Name
PINEYWOODS COMMUNITY 08252008 394 Lynette Cheek
ACADEMY ELEMENTARY
Campus Number Actual Start Date Unique Population Served Phone Number
003801103 08252008 (936)634-5515
Main Campus Close Date Fax Number N
(936)634-5518
Mail Address Physical Address County Grade Levels
602 S Rnguet 602 S Raguet 003 Angelina Prekindergorten 4
Lufkin TX 75904 Lufkin TX 75904
Kindergarten
Grade I
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Update to Data Provided by TEA for
Pirieywoods Community AcademyElementary Campus 003801103
Principal Name - Bruce Marchand
Replaces Lynette Cheek
Section II Contact Information
The persons listed below will be contacted by agency staff if there are issues to be resolved in any of the sections
Superintendent Contact Information
Superintendents Name Bruce Marchand
Telephone Number 936-634-5515
Fax Number 936-634-5518
E-mail Address bmarchandpineywoodsacademyorg
Charter Holder Board Chair Contact Information
Charter Holder Board Dr Neal Naranjo
Chairs Name
Telephone Number 936-634-7979
Fax Number 936-634-7967
E-mail Address asdfnealgmailcom
Application Preparers Contact Information
Contact Name Bruce Marchand
Telephone Number 936-634-5515
Fax Number 936-634-5518
E-mail Address bmarchandpineywoodsacademyorg
Charter School Website
Web address wwwpineywoodsacademyorg
Page 7
Section III Posting of Adopted Budget
Chapter 12 of the Texas Education Code (TEC) specifically sect12104(b)(2)(E) makes explicit that open-enrollment
charters are required to comply with TEC Chapter 39 Subchapter D Financial Accountability TEC sect39084
titled Posting ofAdopted Budget states the following
(a) On final approval of the budget by the board of trustees the school district shall post on the districts Internet
website a copy of the budget adopted by the board of trustees The districts Internet website must prominently
display the electronic link to the adopted budget
(b) The district shall maintain the adopted budget on the districts Internet website until the third anniversary of the
date the budget was adopted
Provide the web address of the adopted budgets
wwwpineywoodsacademyorgaboutbudget
Page 8
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 9
Attachment1
Pineywoods Community Academy
Administrative Position Organizational Chart
Superintendent Elementary Principals
Secondary Principal (Grades 7-12 )
PARAMUS ECHS Principal (9-12)
Elementary Assistant Principal
Special Education Director
Director of Business Operations
Business Manager
Food Service Director
Technology Director
Updated March 2013
Bruce Marchand
Monica Gunter
Merilyn Session
Delbert Murphy
Keri Burton
George Fowler
Tina May
Jim McLeod
Steve Horrocks
Attachment 1A
PCA Board of DirectorsPCA Parents LufkinAngelina County Community1
PCA Executive DirectorSuperintendent]
Director of Business Operations Elem Asst Principal ECHS Principal Secondary Principal
Food Service Director Food Service Staff
Technology Director
Business Manager
Elementary REIMS Clerk
econdary REIMS Clerk
Building Manager Custodians
Elementary Teachers Sebpndary Teaches
Special Education Director
Nurse
dministrative Assistant High School Counselor
Bus Driver
structional Paraprofessionals Day Care Coordinator
School Counselor
Note 1) Director conducts performance appraisals of elementary teachers and elementary special education and intervention teachers
2) Secondary Principal conducts performance appraisals of secondary teachers and secondary special education teachers
3) Supervision and evaluation of Technology Director and PEIMS Clerks is the shared responsibility of the Director of Business Operations Director and Secondary Principal
Revised September 2012
Attachment 2
Not applicable - there are no other entities under the direction of the charter board
REVISED DURING CONTINGENCY PROCESS SEEINSERT
Section V Admission
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadlinefor the submission ofapplicationsfor admission
Beginning of Period End of Period (MonthDay) (MonthDay)
January 2 (or first day of school afterj March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013 q
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One p Yes
(bull No
C Not applicable (because lotteries are not utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
S- 3 1
V D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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 afirst-come first-served admission process when oversubscribed topublish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
Type Below
Page 10
APPROVED DURING CONTINGENCYPROCESS
Section V Admissi
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charier school establish a reasonable application deadlinefor the submission of applicationsfor admission
Beginning of Period End of Period
(MonthDay) (MonthDay)
January 2 (or first day of school afteM March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One 0Yes
No
C Not applicable (because lotteries arenot utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
Students who are currently enrolled and return the Notice of Intent to Return form prior to April Is indicating they wish tocontinue enrollment at PCA are considered enrolled and exempt from an enrollment lottery it the number of applicants exceeds the number of available seats at a grade level In addition any siblings of currently enrolled studentsare given priority in admission to fill any available slots If more than one student at a grade level on the waiting list has a sibling attending PCA a drawing will be heldbetween the eligible siblings todetermine admission
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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
regwres a cAwer scroo W uses proceM Wien overjwkcrifW to a
notice in a newspaper of general circulation not later than the seventh day before the application deadline Type Below
Page 10
F If the school has a separate process for re-enrollment state the process and the timeline to be used
Type Below
Students currently enrolled in Pineywoods Community Academy will receive a Notice of Intent to Return form in early January Parents are to notify the school in writing through the return of the form no later than the last day of January if they intend for their child to attend Pineywoods Community Academy for the next school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currentlyenrolled student without an NIR will be removed from enrollment roster on the last day of March in order to make room for new enrollees Parents who do not return an NIR will be contacted to verify that they do not intend to enroll their student in PCA for the following year
G State the procedures for processing applications received once the application deadline has passed
Type Below
Applications received after the open enrollment date will be processed based on the date received and placed after the names of students chosen by lottery whose applications were received by the open enrollment deadline
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 beprecludedfrom enrolling due to the charter schoolsfailure to receive information requiredfor enrollmentfrom the students parent or guardian orprevious school See TEC sect25002 Type Below
Applicants are required to fill out an enrollment form and must provide current immunization information a birth certificate a copy of the social security card if available and a copy of the parents drivers license Students are not required to provide copies of transcripts or other academic records and 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
I The charter holder certifies that the non-discrimination statement required by TEC sect12111(a)(6) is printed in the schools admission policy TEC sect12111(6) requires that a charter schools admission policy include astatement 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
Check One (gtYes
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories of a criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC sect 12111(a)(6) Check Oneshy
^ Yes ( The school excludes such students or reserves the right to exclude such students from admissions)
pNo (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bull as Attachment 3 a current copy of the admission policy that incorporates the information provided in the aboveahswers to questions A through H and any other relevant information
bull as Attachment 4 a blank copy of the current admission application (ie the information requested when the student first seeks admission) and
bull as Attachment 5 a blank copy of the current enrollment form(s) (ie the information required once an applicant has been offered admission and is registering for enrollment)
Page 11
Attachment 3
Admissions Policy
2013-2014 Admissions Procedure Timeline
Students currently enrolled in Pineywoods Community Academy will receive a Notice ofIntent to Return form in early January Parents are to notify the school in writing through the return of the form no later than Wednesday January 16th 2013 if they intend for their child to attend Pineywoods Community Academy for the 2013-2014 school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currently enrolled student without an NIR will be removed from the 2013-2014 enrollment roster on March 29th 2013 in order to make room for new enrollees
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted during the week of April 1st 2013
During the lottery a name is drawn for each vacancy that is available Each eligible applicants name drawn will be offered admission into Pineywoods Community Academy to fill spaces in that grade level Once available spaces are exhausted the remaining names drawn are placed on a waiting list in the order that the names are drawn PCA will begin notifying accepted applicants during the week of April 8th 2013 Students admitted into the school will be notified as well as students who are placed on a waiting list
If an additional vacancy occurs before the start of school or during the school year the student with the lowest number on the waiting list will be offered enrollment and that name will be removed from the waiting list If an application is received after the enrollment period the applicants name will be placed on the waiting list in the order the application is received In order to accommodate our families if more than one student on the waiting list has a sibling attending PCA a drawing will be held between the eligible siblings to determine admission
Pineywoods Academy does not discriminate on acceptance into the school based on gender national origin ethnicity religion disability academics artistic or athletic ability or the district the child would otherwise attend
Pineywoods Academy may choose to deny admission to students with a documented history of criminal offense juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111(a)(6)
This policy can be accessed from the PCA website at
httpwwwpineywoodsacademyorgadmissionspolicy
eiA Attachment 4 spoundf
AsSfr com
m Student Enrollment Application ypOr 1Pineywoods Community Academy Charter School
2013-2014 School Year
5WshyVS
H
DATE Completed_
Student Information
Students LegalName First Middle Last (as listed on birth certificate)
Gender malefemale Birth date (mdy)_ _ Birth City_ Birth State
Birth Country_ Grade Level for 2013-2014
Is this a repeatgrade YN
Students Street Address_
City State
County_ _Zip_ _Social Security _
Mailing Address (if different from above)
Street City_ State Zip
School District ofResidence
Past EnrollmentDetails
Previous SchoolsAttended (most recentfirst)
School Name School Name
Address Address
City_ State _Zip_ City State _Zip_
Phone _Dates of Attendance Phone _Dates of Attendance
Last Grade Completed atthis school _Last Grade Completed at this school
This school was a Check one This school was a Check one Public School Public School Private SchoolNon-religious Affiliated Private School Non-religious Affiliated Private School Religious Affiliated Private SchoolReligious Affiliated Charter School Charter School Home School Home School School outside of the Country School outsideof the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParcntGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach acopy of thecourt order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applvine to attend PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A
as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (ISS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information provided on this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsificatioti of these recordsfor anypurpose may be prosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
1162013
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APPROVED DISTRICTS
District Names
PALESTINE ISD
HUDSON ISD
LUFKIN ISD
HUNTINGTON ISD
DIBOLL ISD
ZAVALLA ISD
CENTRAL ISD
ALTO ISD
WELLS ISD
NACOGDOCHES ISD
WODEN ISD
ETOILE ISD
CORRIGAN-CAMDEN ISD
BROADDUS ISD
APPLE SPRINGS ISD
COLMESNEIL ISD
ACTION INFORMATION
Type of Amendment
BOARD RELATED
BOARD RELATED
OTHER
ADDRESS CHANGEmdashPHYSICAL
BOARD RELATED
GEOGRAPHIC BOUNDARY - ADD
OTHER
RENEWAL
ADDRESS CHANGEmdashPHYSICAL
OTHER
GRADE LEVEL CHANGE
T E X A S E D U C A T I O N A G E N C Y
CHARTER DETAIL INFORMATION
PINEYWOODS COMMUNITY ACADEMY
003801
County District Numbers
001907
003902
003903
003904
003905
003906
003907
037901
037909
174904
174906
174910
187904
203902
228905
229901
Approval Date Effective Date
01081999 01081999
01142000 01142000
03032000 03032000
05122000 07012000
05122000 05122000
05122000 05122000
10082002 10082002
05132004
07072005
07222005 08042005
04112008 08012008
Information
Description of Amendment
Expand its board of trustees to 7 members
HB211
Remove all references toa professional
management company from its charter and
to amend the charter to make appropriate
provisions for these functions
Change its location as of July 1 2000 to
2515 East Lulkin Avenue Lufkin 75901
Change the structureof the governance
board to follow rules for non-profit
entities to provide for the election of new
boards by existing members
Expand geographic area from Lulkin ISD
to all of Angelina county (to include
Huntington Hudson Central Zavalla and
Diboll ISDs)
Include the following statement
Admission will not be based on gender
national origin ethnicity religion
disability academic artistic orathletic
ability or the district the child would
otherwise attend
Renewal approved for a ten year term See
letter from Commissioner for specific
details
relocate campus 001 from 2515 East
Lulkin Avenue Lulkin Texas 75901 to
602 South Raguet Lulkin Texas 75904
effective August 1 2005
decrease the number ofschool days from
197 to 187 effective August 42005
add a pre-Kindergarten four year old
program to the charters approved grade
levels (K-12) effective the 2008-2009
school year
Page 2 of5
Amendment Status
Approved
Approved
Approved
Approved
Approved
Approved
Approved
Approved
Approved
Approved
Approved
1162013
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Type of Amendment
GEOGRAPHIC BOUNDARY - ADD
OTHER
NAME CHANGE - CAMPUS
OTHER
OTHER
ENROLLMENT CHANGE
VISIT INFORMATION
NA
T E X A S E D U C A T I O N A G E N C Y
CHARTER DETAIL INFORMATION
PINEYWOODS COMMUNITY ACADEMY
003801
Approval Date Effective Date
04112008 08012008
10142008 08252008
08012009
01192010 08012009
05112010 08012010
04202011 08012011
Description of Amendment
expand the charters geographic boundary
to include Corrigan-Camden ISD
Broaddus ISD Alto ISD Nacogdoches
ISD Woden ISD Apple Springs ISD
Palestine ISD and Etoile ISD efffective
the 2008-2009 school year
split the campus as follows
pre-kindergarten through 5th grade and
6th grade through 12th grade (campus
001)efTective August 25 2008
change the name ofcampus 103 from
Pineywoods Community Academy to
Pineywoods Community Academy
Elementary effective August I 2009
change the grade configuration for campus
103 to reflect instruction to PreK-6 grades
and campus 001 to reflect instruction to
7-12 grades effective August I 2009
add the Early College High School
p r o g r a m f o r s t u d e n t s i n g r a d e s 9 - 1 2
effective August 1 2010
increase maximum enrollment from
500 to 750 effective August 1 2011
[Included impact statements for Central
Heights Chireno Cashing Douglas
Garrison and Martinsville ISD which are
NOT on charters approved list may or
may not need to expand boundaries NGG]
Page 3of 5
Amendment Status
Approved
Approved
Approved
Approved
Approved
Approved
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CAMPUS INFORMATION
Campus Name
PINEYWOODS COMMUNITY
ACADEMY HIGH SCHOOL
Campus Number
Main Campus
Y
Mail Address
602 S Raguet
Lufkin TX 75904
T E X A S E D U C A T I O N A G E N C Y
CHARTER DETAIL INFORMATION
IMNEYWOODS COMMUNITY ACADEMY
003801
Approved Date Current Enrollment
09111998 160
Actual Start Date Unique Population Served
08011999
Close Date
Physical Address County
602 S Raguet 003 Angelina
Lufkin TX 75904
Puge 4 of 5
Principal Name
Ms Meriiyn Session
Phone Number
(936) 634-5515
Fax Number
(936) 634-5518
Grade Levels
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Rpt_Dttiil T E X A S E D U C A T I O N A G E N C Y RnRtsof5
11621113 CHARTER DETAIL INFORMATION 91007AM
PINEYWOODS COMMUNITY ACADEMY
003801
CAMPUS INFORMATION
Campus Name Approved Date Current Enrollment Principal Name
PINEYWOODS COMMUNITY 08252008 394 Lynette Cheek
ACADEMY ELEMENTARY
Campus Number Actual Start Date Unique Population Served Phone Number
003801103 08252008 (936)634-5515
Main Campus Close Date Fax Number N
(936)634-5518
Mail Address Physical Address County Grade Levels
602 S Rnguet 602 S Raguet 003 Angelina Prekindergorten 4
Lufkin TX 75904 Lufkin TX 75904
Kindergarten
Grade I
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Update to Data Provided by TEA for
Pirieywoods Community AcademyElementary Campus 003801103
Principal Name - Bruce Marchand
Replaces Lynette Cheek
Section II Contact Information
The persons listed below will be contacted by agency staff if there are issues to be resolved in any of the sections
Superintendent Contact Information
Superintendents Name Bruce Marchand
Telephone Number 936-634-5515
Fax Number 936-634-5518
E-mail Address bmarchandpineywoodsacademyorg
Charter Holder Board Chair Contact Information
Charter Holder Board Dr Neal Naranjo
Chairs Name
Telephone Number 936-634-7979
Fax Number 936-634-7967
E-mail Address asdfnealgmailcom
Application Preparers Contact Information
Contact Name Bruce Marchand
Telephone Number 936-634-5515
Fax Number 936-634-5518
E-mail Address bmarchandpineywoodsacademyorg
Charter School Website
Web address wwwpineywoodsacademyorg
Page 7
Section III Posting of Adopted Budget
Chapter 12 of the Texas Education Code (TEC) specifically sect12104(b)(2)(E) makes explicit that open-enrollment
charters are required to comply with TEC Chapter 39 Subchapter D Financial Accountability TEC sect39084
titled Posting ofAdopted Budget states the following
(a) On final approval of the budget by the board of trustees the school district shall post on the districts Internet
website a copy of the budget adopted by the board of trustees The districts Internet website must prominently
display the electronic link to the adopted budget
(b) The district shall maintain the adopted budget on the districts Internet website until the third anniversary of the
date the budget was adopted
Provide the web address of the adopted budgets
wwwpineywoodsacademyorgaboutbudget
Page 8
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 9
Attachment1
Pineywoods Community Academy
Administrative Position Organizational Chart
Superintendent Elementary Principals
Secondary Principal (Grades 7-12 )
PARAMUS ECHS Principal (9-12)
Elementary Assistant Principal
Special Education Director
Director of Business Operations
Business Manager
Food Service Director
Technology Director
Updated March 2013
Bruce Marchand
Monica Gunter
Merilyn Session
Delbert Murphy
Keri Burton
George Fowler
Tina May
Jim McLeod
Steve Horrocks
Attachment 1A
PCA Board of DirectorsPCA Parents LufkinAngelina County Community1
PCA Executive DirectorSuperintendent]
Director of Business Operations Elem Asst Principal ECHS Principal Secondary Principal
Food Service Director Food Service Staff
Technology Director
Business Manager
Elementary REIMS Clerk
econdary REIMS Clerk
Building Manager Custodians
Elementary Teachers Sebpndary Teaches
Special Education Director
Nurse
dministrative Assistant High School Counselor
Bus Driver
structional Paraprofessionals Day Care Coordinator
School Counselor
Note 1) Director conducts performance appraisals of elementary teachers and elementary special education and intervention teachers
2) Secondary Principal conducts performance appraisals of secondary teachers and secondary special education teachers
3) Supervision and evaluation of Technology Director and PEIMS Clerks is the shared responsibility of the Director of Business Operations Director and Secondary Principal
Revised September 2012
Attachment 2
Not applicable - there are no other entities under the direction of the charter board
REVISED DURING CONTINGENCY PROCESS SEEINSERT
Section V Admission
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadlinefor the submission ofapplicationsfor admission
Beginning of Period End of Period (MonthDay) (MonthDay)
January 2 (or first day of school afterj March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013 q
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One p Yes
(bull No
C Not applicable (because lotteries are not utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
S- 3 1
V D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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 afirst-come first-served admission process when oversubscribed topublish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
Type Below
Page 10
APPROVED DURING CONTINGENCYPROCESS
Section V Admissi
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charier school establish a reasonable application deadlinefor the submission of applicationsfor admission
Beginning of Period End of Period
(MonthDay) (MonthDay)
January 2 (or first day of school afteM March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One 0Yes
No
C Not applicable (because lotteries arenot utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
Students who are currently enrolled and return the Notice of Intent to Return form prior to April Is indicating they wish tocontinue enrollment at PCA are considered enrolled and exempt from an enrollment lottery it the number of applicants exceeds the number of available seats at a grade level In addition any siblings of currently enrolled studentsare given priority in admission to fill any available slots If more than one student at a grade level on the waiting list has a sibling attending PCA a drawing will be heldbetween the eligible siblings todetermine admission
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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
regwres a cAwer scroo W uses proceM Wien overjwkcrifW to a
notice in a newspaper of general circulation not later than the seventh day before the application deadline Type Below
Page 10
F If the school has a separate process for re-enrollment state the process and the timeline to be used
Type Below
Students currently enrolled in Pineywoods Community Academy will receive a Notice of Intent to Return form in early January Parents are to notify the school in writing through the return of the form no later than the last day of January if they intend for their child to attend Pineywoods Community Academy for the next school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currentlyenrolled student without an NIR will be removed from enrollment roster on the last day of March in order to make room for new enrollees Parents who do not return an NIR will be contacted to verify that they do not intend to enroll their student in PCA for the following year
G State the procedures for processing applications received once the application deadline has passed
Type Below
Applications received after the open enrollment date will be processed based on the date received and placed after the names of students chosen by lottery whose applications were received by the open enrollment deadline
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 beprecludedfrom enrolling due to the charter schoolsfailure to receive information requiredfor enrollmentfrom the students parent or guardian orprevious school See TEC sect25002 Type Below
Applicants are required to fill out an enrollment form and must provide current immunization information a birth certificate a copy of the social security card if available and a copy of the parents drivers license Students are not required to provide copies of transcripts or other academic records and 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
I The charter holder certifies that the non-discrimination statement required by TEC sect12111(a)(6) is printed in the schools admission policy TEC sect12111(6) requires that a charter schools admission policy include astatement 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
Check One (gtYes
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories of a criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC sect 12111(a)(6) Check Oneshy
^ Yes ( The school excludes such students or reserves the right to exclude such students from admissions)
pNo (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bull as Attachment 3 a current copy of the admission policy that incorporates the information provided in the aboveahswers to questions A through H and any other relevant information
bull as Attachment 4 a blank copy of the current admission application (ie the information requested when the student first seeks admission) and
bull as Attachment 5 a blank copy of the current enrollment form(s) (ie the information required once an applicant has been offered admission and is registering for enrollment)
Page 11
Attachment 3
Admissions Policy
2013-2014 Admissions Procedure Timeline
Students currently enrolled in Pineywoods Community Academy will receive a Notice ofIntent to Return form in early January Parents are to notify the school in writing through the return of the form no later than Wednesday January 16th 2013 if they intend for their child to attend Pineywoods Community Academy for the 2013-2014 school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currently enrolled student without an NIR will be removed from the 2013-2014 enrollment roster on March 29th 2013 in order to make room for new enrollees
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted during the week of April 1st 2013
During the lottery a name is drawn for each vacancy that is available Each eligible applicants name drawn will be offered admission into Pineywoods Community Academy to fill spaces in that grade level Once available spaces are exhausted the remaining names drawn are placed on a waiting list in the order that the names are drawn PCA will begin notifying accepted applicants during the week of April 8th 2013 Students admitted into the school will be notified as well as students who are placed on a waiting list
If an additional vacancy occurs before the start of school or during the school year the student with the lowest number on the waiting list will be offered enrollment and that name will be removed from the waiting list If an application is received after the enrollment period the applicants name will be placed on the waiting list in the order the application is received In order to accommodate our families if more than one student on the waiting list has a sibling attending PCA a drawing will be held between the eligible siblings to determine admission
Pineywoods Academy does not discriminate on acceptance into the school based on gender national origin ethnicity religion disability academics artistic or athletic ability or the district the child would otherwise attend
Pineywoods Academy may choose to deny admission to students with a documented history of criminal offense juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111(a)(6)
This policy can be accessed from the PCA website at
httpwwwpineywoodsacademyorgadmissionspolicy
eiA Attachment 4 spoundf
AsSfr com
m Student Enrollment Application ypOr 1Pineywoods Community Academy Charter School
2013-2014 School Year
5WshyVS
H
DATE Completed_
Student Information
Students LegalName First Middle Last (as listed on birth certificate)
Gender malefemale Birth date (mdy)_ _ Birth City_ Birth State
Birth Country_ Grade Level for 2013-2014
Is this a repeatgrade YN
Students Street Address_
City State
County_ _Zip_ _Social Security _
Mailing Address (if different from above)
Street City_ State Zip
School District ofResidence
Past EnrollmentDetails
Previous SchoolsAttended (most recentfirst)
School Name School Name
Address Address
City_ State _Zip_ City State _Zip_
Phone _Dates of Attendance Phone _Dates of Attendance
Last Grade Completed atthis school _Last Grade Completed at this school
This school was a Check one This school was a Check one Public School Public School Private SchoolNon-religious Affiliated Private School Non-religious Affiliated Private School Religious Affiliated Private SchoolReligious Affiliated Charter School Charter School Home School Home School School outside of the Country School outsideof the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParcntGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach acopy of thecourt order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applvine to attend PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A
as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (ISS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information provided on this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsificatioti of these recordsfor anypurpose may be prosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
1162013
Rpt_Detail
91007AM
Type of Amendment
GEOGRAPHIC BOUNDARY - ADD
OTHER
NAME CHANGE - CAMPUS
OTHER
OTHER
ENROLLMENT CHANGE
VISIT INFORMATION
NA
T E X A S E D U C A T I O N A G E N C Y
CHARTER DETAIL INFORMATION
PINEYWOODS COMMUNITY ACADEMY
003801
Approval Date Effective Date
04112008 08012008
10142008 08252008
08012009
01192010 08012009
05112010 08012010
04202011 08012011
Description of Amendment
expand the charters geographic boundary
to include Corrigan-Camden ISD
Broaddus ISD Alto ISD Nacogdoches
ISD Woden ISD Apple Springs ISD
Palestine ISD and Etoile ISD efffective
the 2008-2009 school year
split the campus as follows
pre-kindergarten through 5th grade and
6th grade through 12th grade (campus
001)efTective August 25 2008
change the name ofcampus 103 from
Pineywoods Community Academy to
Pineywoods Community Academy
Elementary effective August I 2009
change the grade configuration for campus
103 to reflect instruction to PreK-6 grades
and campus 001 to reflect instruction to
7-12 grades effective August I 2009
add the Early College High School
p r o g r a m f o r s t u d e n t s i n g r a d e s 9 - 1 2
effective August 1 2010
increase maximum enrollment from
500 to 750 effective August 1 2011
[Included impact statements for Central
Heights Chireno Cashing Douglas
Garrison and Martinsville ISD which are
NOT on charters approved list may or
may not need to expand boundaries NGG]
Page 3of 5
Amendment Status
Approved
Approved
Approved
Approved
Approved
Approved
1162013
003801001
Rpt_Detai
91007AM
CAMPUS INFORMATION
Campus Name
PINEYWOODS COMMUNITY
ACADEMY HIGH SCHOOL
Campus Number
Main Campus
Y
Mail Address
602 S Raguet
Lufkin TX 75904
T E X A S E D U C A T I O N A G E N C Y
CHARTER DETAIL INFORMATION
IMNEYWOODS COMMUNITY ACADEMY
003801
Approved Date Current Enrollment
09111998 160
Actual Start Date Unique Population Served
08011999
Close Date
Physical Address County
602 S Raguet 003 Angelina
Lufkin TX 75904
Puge 4 of 5
Principal Name
Ms Meriiyn Session
Phone Number
(936) 634-5515
Fax Number
(936) 634-5518
Grade Levels
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Rpt_Dttiil T E X A S E D U C A T I O N A G E N C Y RnRtsof5
11621113 CHARTER DETAIL INFORMATION 91007AM
PINEYWOODS COMMUNITY ACADEMY
003801
CAMPUS INFORMATION
Campus Name Approved Date Current Enrollment Principal Name
PINEYWOODS COMMUNITY 08252008 394 Lynette Cheek
ACADEMY ELEMENTARY
Campus Number Actual Start Date Unique Population Served Phone Number
003801103 08252008 (936)634-5515
Main Campus Close Date Fax Number N
(936)634-5518
Mail Address Physical Address County Grade Levels
602 S Rnguet 602 S Raguet 003 Angelina Prekindergorten 4
Lufkin TX 75904 Lufkin TX 75904
Kindergarten
Grade I
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Update to Data Provided by TEA for
Pirieywoods Community AcademyElementary Campus 003801103
Principal Name - Bruce Marchand
Replaces Lynette Cheek
Section II Contact Information
The persons listed below will be contacted by agency staff if there are issues to be resolved in any of the sections
Superintendent Contact Information
Superintendents Name Bruce Marchand
Telephone Number 936-634-5515
Fax Number 936-634-5518
E-mail Address bmarchandpineywoodsacademyorg
Charter Holder Board Chair Contact Information
Charter Holder Board Dr Neal Naranjo
Chairs Name
Telephone Number 936-634-7979
Fax Number 936-634-7967
E-mail Address asdfnealgmailcom
Application Preparers Contact Information
Contact Name Bruce Marchand
Telephone Number 936-634-5515
Fax Number 936-634-5518
E-mail Address bmarchandpineywoodsacademyorg
Charter School Website
Web address wwwpineywoodsacademyorg
Page 7
Section III Posting of Adopted Budget
Chapter 12 of the Texas Education Code (TEC) specifically sect12104(b)(2)(E) makes explicit that open-enrollment
charters are required to comply with TEC Chapter 39 Subchapter D Financial Accountability TEC sect39084
titled Posting ofAdopted Budget states the following
(a) On final approval of the budget by the board of trustees the school district shall post on the districts Internet
website a copy of the budget adopted by the board of trustees The districts Internet website must prominently
display the electronic link to the adopted budget
(b) The district shall maintain the adopted budget on the districts Internet website until the third anniversary of the
date the budget was adopted
Provide the web address of the adopted budgets
wwwpineywoodsacademyorgaboutbudget
Page 8
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 9
Attachment1
Pineywoods Community Academy
Administrative Position Organizational Chart
Superintendent Elementary Principals
Secondary Principal (Grades 7-12 )
PARAMUS ECHS Principal (9-12)
Elementary Assistant Principal
Special Education Director
Director of Business Operations
Business Manager
Food Service Director
Technology Director
Updated March 2013
Bruce Marchand
Monica Gunter
Merilyn Session
Delbert Murphy
Keri Burton
George Fowler
Tina May
Jim McLeod
Steve Horrocks
Attachment 1A
PCA Board of DirectorsPCA Parents LufkinAngelina County Community1
PCA Executive DirectorSuperintendent]
Director of Business Operations Elem Asst Principal ECHS Principal Secondary Principal
Food Service Director Food Service Staff
Technology Director
Business Manager
Elementary REIMS Clerk
econdary REIMS Clerk
Building Manager Custodians
Elementary Teachers Sebpndary Teaches
Special Education Director
Nurse
dministrative Assistant High School Counselor
Bus Driver
structional Paraprofessionals Day Care Coordinator
School Counselor
Note 1) Director conducts performance appraisals of elementary teachers and elementary special education and intervention teachers
2) Secondary Principal conducts performance appraisals of secondary teachers and secondary special education teachers
3) Supervision and evaluation of Technology Director and PEIMS Clerks is the shared responsibility of the Director of Business Operations Director and Secondary Principal
Revised September 2012
Attachment 2
Not applicable - there are no other entities under the direction of the charter board
REVISED DURING CONTINGENCY PROCESS SEEINSERT
Section V Admission
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadlinefor the submission ofapplicationsfor admission
Beginning of Period End of Period (MonthDay) (MonthDay)
January 2 (or first day of school afterj March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013 q
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One p Yes
(bull No
C Not applicable (because lotteries are not utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
S- 3 1
V D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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 afirst-come first-served admission process when oversubscribed topublish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
Type Below
Page 10
APPROVED DURING CONTINGENCYPROCESS
Section V Admissi
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charier school establish a reasonable application deadlinefor the submission of applicationsfor admission
Beginning of Period End of Period
(MonthDay) (MonthDay)
January 2 (or first day of school afteM March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One 0Yes
No
C Not applicable (because lotteries arenot utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
Students who are currently enrolled and return the Notice of Intent to Return form prior to April Is indicating they wish tocontinue enrollment at PCA are considered enrolled and exempt from an enrollment lottery it the number of applicants exceeds the number of available seats at a grade level In addition any siblings of currently enrolled studentsare given priority in admission to fill any available slots If more than one student at a grade level on the waiting list has a sibling attending PCA a drawing will be heldbetween the eligible siblings todetermine admission
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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
regwres a cAwer scroo W uses proceM Wien overjwkcrifW to a
notice in a newspaper of general circulation not later than the seventh day before the application deadline Type Below
Page 10
F If the school has a separate process for re-enrollment state the process and the timeline to be used
Type Below
Students currently enrolled in Pineywoods Community Academy will receive a Notice of Intent to Return form in early January Parents are to notify the school in writing through the return of the form no later than the last day of January if they intend for their child to attend Pineywoods Community Academy for the next school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currentlyenrolled student without an NIR will be removed from enrollment roster on the last day of March in order to make room for new enrollees Parents who do not return an NIR will be contacted to verify that they do not intend to enroll their student in PCA for the following year
G State the procedures for processing applications received once the application deadline has passed
Type Below
Applications received after the open enrollment date will be processed based on the date received and placed after the names of students chosen by lottery whose applications were received by the open enrollment deadline
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 beprecludedfrom enrolling due to the charter schoolsfailure to receive information requiredfor enrollmentfrom the students parent or guardian orprevious school See TEC sect25002 Type Below
Applicants are required to fill out an enrollment form and must provide current immunization information a birth certificate a copy of the social security card if available and a copy of the parents drivers license Students are not required to provide copies of transcripts or other academic records and 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
I The charter holder certifies that the non-discrimination statement required by TEC sect12111(a)(6) is printed in the schools admission policy TEC sect12111(6) requires that a charter schools admission policy include astatement 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
Check One (gtYes
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories of a criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC sect 12111(a)(6) Check Oneshy
^ Yes ( The school excludes such students or reserves the right to exclude such students from admissions)
pNo (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bull as Attachment 3 a current copy of the admission policy that incorporates the information provided in the aboveahswers to questions A through H and any other relevant information
bull as Attachment 4 a blank copy of the current admission application (ie the information requested when the student first seeks admission) and
bull as Attachment 5 a blank copy of the current enrollment form(s) (ie the information required once an applicant has been offered admission and is registering for enrollment)
Page 11
Attachment 3
Admissions Policy
2013-2014 Admissions Procedure Timeline
Students currently enrolled in Pineywoods Community Academy will receive a Notice ofIntent to Return form in early January Parents are to notify the school in writing through the return of the form no later than Wednesday January 16th 2013 if they intend for their child to attend Pineywoods Community Academy for the 2013-2014 school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currently enrolled student without an NIR will be removed from the 2013-2014 enrollment roster on March 29th 2013 in order to make room for new enrollees
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted during the week of April 1st 2013
During the lottery a name is drawn for each vacancy that is available Each eligible applicants name drawn will be offered admission into Pineywoods Community Academy to fill spaces in that grade level Once available spaces are exhausted the remaining names drawn are placed on a waiting list in the order that the names are drawn PCA will begin notifying accepted applicants during the week of April 8th 2013 Students admitted into the school will be notified as well as students who are placed on a waiting list
If an additional vacancy occurs before the start of school or during the school year the student with the lowest number on the waiting list will be offered enrollment and that name will be removed from the waiting list If an application is received after the enrollment period the applicants name will be placed on the waiting list in the order the application is received In order to accommodate our families if more than one student on the waiting list has a sibling attending PCA a drawing will be held between the eligible siblings to determine admission
Pineywoods Academy does not discriminate on acceptance into the school based on gender national origin ethnicity religion disability academics artistic or athletic ability or the district the child would otherwise attend
Pineywoods Academy may choose to deny admission to students with a documented history of criminal offense juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111(a)(6)
This policy can be accessed from the PCA website at
httpwwwpineywoodsacademyorgadmissionspolicy
eiA Attachment 4 spoundf
AsSfr com
m Student Enrollment Application ypOr 1Pineywoods Community Academy Charter School
2013-2014 School Year
5WshyVS
H
DATE Completed_
Student Information
Students LegalName First Middle Last (as listed on birth certificate)
Gender malefemale Birth date (mdy)_ _ Birth City_ Birth State
Birth Country_ Grade Level for 2013-2014
Is this a repeatgrade YN
Students Street Address_
City State
County_ _Zip_ _Social Security _
Mailing Address (if different from above)
Street City_ State Zip
School District ofResidence
Past EnrollmentDetails
Previous SchoolsAttended (most recentfirst)
School Name School Name
Address Address
City_ State _Zip_ City State _Zip_
Phone _Dates of Attendance Phone _Dates of Attendance
Last Grade Completed atthis school _Last Grade Completed at this school
This school was a Check one This school was a Check one Public School Public School Private SchoolNon-religious Affiliated Private School Non-religious Affiliated Private School Religious Affiliated Private SchoolReligious Affiliated Charter School Charter School Home School Home School School outside of the Country School outsideof the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParcntGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach acopy of thecourt order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applvine to attend PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A
as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (ISS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information provided on this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsificatioti of these recordsfor anypurpose may be prosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
1162013
003801001
Rpt_Detai
91007AM
CAMPUS INFORMATION
Campus Name
PINEYWOODS COMMUNITY
ACADEMY HIGH SCHOOL
Campus Number
Main Campus
Y
Mail Address
602 S Raguet
Lufkin TX 75904
T E X A S E D U C A T I O N A G E N C Y
CHARTER DETAIL INFORMATION
IMNEYWOODS COMMUNITY ACADEMY
003801
Approved Date Current Enrollment
09111998 160
Actual Start Date Unique Population Served
08011999
Close Date
Physical Address County
602 S Raguet 003 Angelina
Lufkin TX 75904
Puge 4 of 5
Principal Name
Ms Meriiyn Session
Phone Number
(936) 634-5515
Fax Number
(936) 634-5518
Grade Levels
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Rpt_Dttiil T E X A S E D U C A T I O N A G E N C Y RnRtsof5
11621113 CHARTER DETAIL INFORMATION 91007AM
PINEYWOODS COMMUNITY ACADEMY
003801
CAMPUS INFORMATION
Campus Name Approved Date Current Enrollment Principal Name
PINEYWOODS COMMUNITY 08252008 394 Lynette Cheek
ACADEMY ELEMENTARY
Campus Number Actual Start Date Unique Population Served Phone Number
003801103 08252008 (936)634-5515
Main Campus Close Date Fax Number N
(936)634-5518
Mail Address Physical Address County Grade Levels
602 S Rnguet 602 S Raguet 003 Angelina Prekindergorten 4
Lufkin TX 75904 Lufkin TX 75904
Kindergarten
Grade I
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Update to Data Provided by TEA for
Pirieywoods Community AcademyElementary Campus 003801103
Principal Name - Bruce Marchand
Replaces Lynette Cheek
Section II Contact Information
The persons listed below will be contacted by agency staff if there are issues to be resolved in any of the sections
Superintendent Contact Information
Superintendents Name Bruce Marchand
Telephone Number 936-634-5515
Fax Number 936-634-5518
E-mail Address bmarchandpineywoodsacademyorg
Charter Holder Board Chair Contact Information
Charter Holder Board Dr Neal Naranjo
Chairs Name
Telephone Number 936-634-7979
Fax Number 936-634-7967
E-mail Address asdfnealgmailcom
Application Preparers Contact Information
Contact Name Bruce Marchand
Telephone Number 936-634-5515
Fax Number 936-634-5518
E-mail Address bmarchandpineywoodsacademyorg
Charter School Website
Web address wwwpineywoodsacademyorg
Page 7
Section III Posting of Adopted Budget
Chapter 12 of the Texas Education Code (TEC) specifically sect12104(b)(2)(E) makes explicit that open-enrollment
charters are required to comply with TEC Chapter 39 Subchapter D Financial Accountability TEC sect39084
titled Posting ofAdopted Budget states the following
(a) On final approval of the budget by the board of trustees the school district shall post on the districts Internet
website a copy of the budget adopted by the board of trustees The districts Internet website must prominently
display the electronic link to the adopted budget
(b) The district shall maintain the adopted budget on the districts Internet website until the third anniversary of the
date the budget was adopted
Provide the web address of the adopted budgets
wwwpineywoodsacademyorgaboutbudget
Page 8
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 9
Attachment1
Pineywoods Community Academy
Administrative Position Organizational Chart
Superintendent Elementary Principals
Secondary Principal (Grades 7-12 )
PARAMUS ECHS Principal (9-12)
Elementary Assistant Principal
Special Education Director
Director of Business Operations
Business Manager
Food Service Director
Technology Director
Updated March 2013
Bruce Marchand
Monica Gunter
Merilyn Session
Delbert Murphy
Keri Burton
George Fowler
Tina May
Jim McLeod
Steve Horrocks
Attachment 1A
PCA Board of DirectorsPCA Parents LufkinAngelina County Community1
PCA Executive DirectorSuperintendent]
Director of Business Operations Elem Asst Principal ECHS Principal Secondary Principal
Food Service Director Food Service Staff
Technology Director
Business Manager
Elementary REIMS Clerk
econdary REIMS Clerk
Building Manager Custodians
Elementary Teachers Sebpndary Teaches
Special Education Director
Nurse
dministrative Assistant High School Counselor
Bus Driver
structional Paraprofessionals Day Care Coordinator
School Counselor
Note 1) Director conducts performance appraisals of elementary teachers and elementary special education and intervention teachers
2) Secondary Principal conducts performance appraisals of secondary teachers and secondary special education teachers
3) Supervision and evaluation of Technology Director and PEIMS Clerks is the shared responsibility of the Director of Business Operations Director and Secondary Principal
Revised September 2012
Attachment 2
Not applicable - there are no other entities under the direction of the charter board
REVISED DURING CONTINGENCY PROCESS SEEINSERT
Section V Admission
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadlinefor the submission ofapplicationsfor admission
Beginning of Period End of Period (MonthDay) (MonthDay)
January 2 (or first day of school afterj March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013 q
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One p Yes
(bull No
C Not applicable (because lotteries are not utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
S- 3 1
V D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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 afirst-come first-served admission process when oversubscribed topublish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
Type Below
Page 10
APPROVED DURING CONTINGENCYPROCESS
Section V Admissi
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charier school establish a reasonable application deadlinefor the submission of applicationsfor admission
Beginning of Period End of Period
(MonthDay) (MonthDay)
January 2 (or first day of school afteM March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One 0Yes
No
C Not applicable (because lotteries arenot utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
Students who are currently enrolled and return the Notice of Intent to Return form prior to April Is indicating they wish tocontinue enrollment at PCA are considered enrolled and exempt from an enrollment lottery it the number of applicants exceeds the number of available seats at a grade level In addition any siblings of currently enrolled studentsare given priority in admission to fill any available slots If more than one student at a grade level on the waiting list has a sibling attending PCA a drawing will be heldbetween the eligible siblings todetermine admission
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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
regwres a cAwer scroo W uses proceM Wien overjwkcrifW to a
notice in a newspaper of general circulation not later than the seventh day before the application deadline Type Below
Page 10
F If the school has a separate process for re-enrollment state the process and the timeline to be used
Type Below
Students currently enrolled in Pineywoods Community Academy will receive a Notice of Intent to Return form in early January Parents are to notify the school in writing through the return of the form no later than the last day of January if they intend for their child to attend Pineywoods Community Academy for the next school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currentlyenrolled student without an NIR will be removed from enrollment roster on the last day of March in order to make room for new enrollees Parents who do not return an NIR will be contacted to verify that they do not intend to enroll their student in PCA for the following year
G State the procedures for processing applications received once the application deadline has passed
Type Below
Applications received after the open enrollment date will be processed based on the date received and placed after the names of students chosen by lottery whose applications were received by the open enrollment deadline
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 beprecludedfrom enrolling due to the charter schoolsfailure to receive information requiredfor enrollmentfrom the students parent or guardian orprevious school See TEC sect25002 Type Below
Applicants are required to fill out an enrollment form and must provide current immunization information a birth certificate a copy of the social security card if available and a copy of the parents drivers license Students are not required to provide copies of transcripts or other academic records and 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
I The charter holder certifies that the non-discrimination statement required by TEC sect12111(a)(6) is printed in the schools admission policy TEC sect12111(6) requires that a charter schools admission policy include astatement 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
Check One (gtYes
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories of a criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC sect 12111(a)(6) Check Oneshy
^ Yes ( The school excludes such students or reserves the right to exclude such students from admissions)
pNo (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bull as Attachment 3 a current copy of the admission policy that incorporates the information provided in the aboveahswers to questions A through H and any other relevant information
bull as Attachment 4 a blank copy of the current admission application (ie the information requested when the student first seeks admission) and
bull as Attachment 5 a blank copy of the current enrollment form(s) (ie the information required once an applicant has been offered admission and is registering for enrollment)
Page 11
Attachment 3
Admissions Policy
2013-2014 Admissions Procedure Timeline
Students currently enrolled in Pineywoods Community Academy will receive a Notice ofIntent to Return form in early January Parents are to notify the school in writing through the return of the form no later than Wednesday January 16th 2013 if they intend for their child to attend Pineywoods Community Academy for the 2013-2014 school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currently enrolled student without an NIR will be removed from the 2013-2014 enrollment roster on March 29th 2013 in order to make room for new enrollees
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted during the week of April 1st 2013
During the lottery a name is drawn for each vacancy that is available Each eligible applicants name drawn will be offered admission into Pineywoods Community Academy to fill spaces in that grade level Once available spaces are exhausted the remaining names drawn are placed on a waiting list in the order that the names are drawn PCA will begin notifying accepted applicants during the week of April 8th 2013 Students admitted into the school will be notified as well as students who are placed on a waiting list
If an additional vacancy occurs before the start of school or during the school year the student with the lowest number on the waiting list will be offered enrollment and that name will be removed from the waiting list If an application is received after the enrollment period the applicants name will be placed on the waiting list in the order the application is received In order to accommodate our families if more than one student on the waiting list has a sibling attending PCA a drawing will be held between the eligible siblings to determine admission
Pineywoods Academy does not discriminate on acceptance into the school based on gender national origin ethnicity religion disability academics artistic or athletic ability or the district the child would otherwise attend
Pineywoods Academy may choose to deny admission to students with a documented history of criminal offense juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111(a)(6)
This policy can be accessed from the PCA website at
httpwwwpineywoodsacademyorgadmissionspolicy
eiA Attachment 4 spoundf
AsSfr com
m Student Enrollment Application ypOr 1Pineywoods Community Academy Charter School
2013-2014 School Year
5WshyVS
H
DATE Completed_
Student Information
Students LegalName First Middle Last (as listed on birth certificate)
Gender malefemale Birth date (mdy)_ _ Birth City_ Birth State
Birth Country_ Grade Level for 2013-2014
Is this a repeatgrade YN
Students Street Address_
City State
County_ _Zip_ _Social Security _
Mailing Address (if different from above)
Street City_ State Zip
School District ofResidence
Past EnrollmentDetails
Previous SchoolsAttended (most recentfirst)
School Name School Name
Address Address
City_ State _Zip_ City State _Zip_
Phone _Dates of Attendance Phone _Dates of Attendance
Last Grade Completed atthis school _Last Grade Completed at this school
This school was a Check one This school was a Check one Public School Public School Private SchoolNon-religious Affiliated Private School Non-religious Affiliated Private School Religious Affiliated Private SchoolReligious Affiliated Charter School Charter School Home School Home School School outside of the Country School outsideof the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParcntGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach acopy of thecourt order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applvine to attend PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A
as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (ISS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information provided on this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsificatioti of these recordsfor anypurpose may be prosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
Rpt_Dttiil T E X A S E D U C A T I O N A G E N C Y RnRtsof5
11621113 CHARTER DETAIL INFORMATION 91007AM
PINEYWOODS COMMUNITY ACADEMY
003801
CAMPUS INFORMATION
Campus Name Approved Date Current Enrollment Principal Name
PINEYWOODS COMMUNITY 08252008 394 Lynette Cheek
ACADEMY ELEMENTARY
Campus Number Actual Start Date Unique Population Served Phone Number
003801103 08252008 (936)634-5515
Main Campus Close Date Fax Number N
(936)634-5518
Mail Address Physical Address County Grade Levels
602 S Rnguet 602 S Raguet 003 Angelina Prekindergorten 4
Lufkin TX 75904 Lufkin TX 75904
Kindergarten
Grade I
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Update to Data Provided by TEA for
Pirieywoods Community AcademyElementary Campus 003801103
Principal Name - Bruce Marchand
Replaces Lynette Cheek
Section II Contact Information
The persons listed below will be contacted by agency staff if there are issues to be resolved in any of the sections
Superintendent Contact Information
Superintendents Name Bruce Marchand
Telephone Number 936-634-5515
Fax Number 936-634-5518
E-mail Address bmarchandpineywoodsacademyorg
Charter Holder Board Chair Contact Information
Charter Holder Board Dr Neal Naranjo
Chairs Name
Telephone Number 936-634-7979
Fax Number 936-634-7967
E-mail Address asdfnealgmailcom
Application Preparers Contact Information
Contact Name Bruce Marchand
Telephone Number 936-634-5515
Fax Number 936-634-5518
E-mail Address bmarchandpineywoodsacademyorg
Charter School Website
Web address wwwpineywoodsacademyorg
Page 7
Section III Posting of Adopted Budget
Chapter 12 of the Texas Education Code (TEC) specifically sect12104(b)(2)(E) makes explicit that open-enrollment
charters are required to comply with TEC Chapter 39 Subchapter D Financial Accountability TEC sect39084
titled Posting ofAdopted Budget states the following
(a) On final approval of the budget by the board of trustees the school district shall post on the districts Internet
website a copy of the budget adopted by the board of trustees The districts Internet website must prominently
display the electronic link to the adopted budget
(b) The district shall maintain the adopted budget on the districts Internet website until the third anniversary of the
date the budget was adopted
Provide the web address of the adopted budgets
wwwpineywoodsacademyorgaboutbudget
Page 8
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 9
Attachment1
Pineywoods Community Academy
Administrative Position Organizational Chart
Superintendent Elementary Principals
Secondary Principal (Grades 7-12 )
PARAMUS ECHS Principal (9-12)
Elementary Assistant Principal
Special Education Director
Director of Business Operations
Business Manager
Food Service Director
Technology Director
Updated March 2013
Bruce Marchand
Monica Gunter
Merilyn Session
Delbert Murphy
Keri Burton
George Fowler
Tina May
Jim McLeod
Steve Horrocks
Attachment 1A
PCA Board of DirectorsPCA Parents LufkinAngelina County Community1
PCA Executive DirectorSuperintendent]
Director of Business Operations Elem Asst Principal ECHS Principal Secondary Principal
Food Service Director Food Service Staff
Technology Director
Business Manager
Elementary REIMS Clerk
econdary REIMS Clerk
Building Manager Custodians
Elementary Teachers Sebpndary Teaches
Special Education Director
Nurse
dministrative Assistant High School Counselor
Bus Driver
structional Paraprofessionals Day Care Coordinator
School Counselor
Note 1) Director conducts performance appraisals of elementary teachers and elementary special education and intervention teachers
2) Secondary Principal conducts performance appraisals of secondary teachers and secondary special education teachers
3) Supervision and evaluation of Technology Director and PEIMS Clerks is the shared responsibility of the Director of Business Operations Director and Secondary Principal
Revised September 2012
Attachment 2
Not applicable - there are no other entities under the direction of the charter board
REVISED DURING CONTINGENCY PROCESS SEEINSERT
Section V Admission
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadlinefor the submission ofapplicationsfor admission
Beginning of Period End of Period (MonthDay) (MonthDay)
January 2 (or first day of school afterj March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013 q
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One p Yes
(bull No
C Not applicable (because lotteries are not utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
S- 3 1
V D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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 afirst-come first-served admission process when oversubscribed topublish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
Type Below
Page 10
APPROVED DURING CONTINGENCYPROCESS
Section V Admissi
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charier school establish a reasonable application deadlinefor the submission of applicationsfor admission
Beginning of Period End of Period
(MonthDay) (MonthDay)
January 2 (or first day of school afteM March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One 0Yes
No
C Not applicable (because lotteries arenot utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
Students who are currently enrolled and return the Notice of Intent to Return form prior to April Is indicating they wish tocontinue enrollment at PCA are considered enrolled and exempt from an enrollment lottery it the number of applicants exceeds the number of available seats at a grade level In addition any siblings of currently enrolled studentsare given priority in admission to fill any available slots If more than one student at a grade level on the waiting list has a sibling attending PCA a drawing will be heldbetween the eligible siblings todetermine admission
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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
regwres a cAwer scroo W uses proceM Wien overjwkcrifW to a
notice in a newspaper of general circulation not later than the seventh day before the application deadline Type Below
Page 10
F If the school has a separate process for re-enrollment state the process and the timeline to be used
Type Below
Students currently enrolled in Pineywoods Community Academy will receive a Notice of Intent to Return form in early January Parents are to notify the school in writing through the return of the form no later than the last day of January if they intend for their child to attend Pineywoods Community Academy for the next school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currentlyenrolled student without an NIR will be removed from enrollment roster on the last day of March in order to make room for new enrollees Parents who do not return an NIR will be contacted to verify that they do not intend to enroll their student in PCA for the following year
G State the procedures for processing applications received once the application deadline has passed
Type Below
Applications received after the open enrollment date will be processed based on the date received and placed after the names of students chosen by lottery whose applications were received by the open enrollment deadline
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 beprecludedfrom enrolling due to the charter schoolsfailure to receive information requiredfor enrollmentfrom the students parent or guardian orprevious school See TEC sect25002 Type Below
Applicants are required to fill out an enrollment form and must provide current immunization information a birth certificate a copy of the social security card if available and a copy of the parents drivers license Students are not required to provide copies of transcripts or other academic records and 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
I The charter holder certifies that the non-discrimination statement required by TEC sect12111(a)(6) is printed in the schools admission policy TEC sect12111(6) requires that a charter schools admission policy include astatement 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
Check One (gtYes
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories of a criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC sect 12111(a)(6) Check Oneshy
^ Yes ( The school excludes such students or reserves the right to exclude such students from admissions)
pNo (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bull as Attachment 3 a current copy of the admission policy that incorporates the information provided in the aboveahswers to questions A through H and any other relevant information
bull as Attachment 4 a blank copy of the current admission application (ie the information requested when the student first seeks admission) and
bull as Attachment 5 a blank copy of the current enrollment form(s) (ie the information required once an applicant has been offered admission and is registering for enrollment)
Page 11
Attachment 3
Admissions Policy
2013-2014 Admissions Procedure Timeline
Students currently enrolled in Pineywoods Community Academy will receive a Notice ofIntent to Return form in early January Parents are to notify the school in writing through the return of the form no later than Wednesday January 16th 2013 if they intend for their child to attend Pineywoods Community Academy for the 2013-2014 school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currently enrolled student without an NIR will be removed from the 2013-2014 enrollment roster on March 29th 2013 in order to make room for new enrollees
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted during the week of April 1st 2013
During the lottery a name is drawn for each vacancy that is available Each eligible applicants name drawn will be offered admission into Pineywoods Community Academy to fill spaces in that grade level Once available spaces are exhausted the remaining names drawn are placed on a waiting list in the order that the names are drawn PCA will begin notifying accepted applicants during the week of April 8th 2013 Students admitted into the school will be notified as well as students who are placed on a waiting list
If an additional vacancy occurs before the start of school or during the school year the student with the lowest number on the waiting list will be offered enrollment and that name will be removed from the waiting list If an application is received after the enrollment period the applicants name will be placed on the waiting list in the order the application is received In order to accommodate our families if more than one student on the waiting list has a sibling attending PCA a drawing will be held between the eligible siblings to determine admission
Pineywoods Academy does not discriminate on acceptance into the school based on gender national origin ethnicity religion disability academics artistic or athletic ability or the district the child would otherwise attend
Pineywoods Academy may choose to deny admission to students with a documented history of criminal offense juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111(a)(6)
This policy can be accessed from the PCA website at
httpwwwpineywoodsacademyorgadmissionspolicy
eiA Attachment 4 spoundf
AsSfr com
m Student Enrollment Application ypOr 1Pineywoods Community Academy Charter School
2013-2014 School Year
5WshyVS
H
DATE Completed_
Student Information
Students LegalName First Middle Last (as listed on birth certificate)
Gender malefemale Birth date (mdy)_ _ Birth City_ Birth State
Birth Country_ Grade Level for 2013-2014
Is this a repeatgrade YN
Students Street Address_
City State
County_ _Zip_ _Social Security _
Mailing Address (if different from above)
Street City_ State Zip
School District ofResidence
Past EnrollmentDetails
Previous SchoolsAttended (most recentfirst)
School Name School Name
Address Address
City_ State _Zip_ City State _Zip_
Phone _Dates of Attendance Phone _Dates of Attendance
Last Grade Completed atthis school _Last Grade Completed at this school
This school was a Check one This school was a Check one Public School Public School Private SchoolNon-religious Affiliated Private School Non-religious Affiliated Private School Religious Affiliated Private SchoolReligious Affiliated Charter School Charter School Home School Home School School outside of the Country School outsideof the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParcntGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach acopy of thecourt order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applvine to attend PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A
as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (ISS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information provided on this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsificatioti of these recordsfor anypurpose may be prosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
Update to Data Provided by TEA for
Pirieywoods Community AcademyElementary Campus 003801103
Principal Name - Bruce Marchand
Replaces Lynette Cheek
Section II Contact Information
The persons listed below will be contacted by agency staff if there are issues to be resolved in any of the sections
Superintendent Contact Information
Superintendents Name Bruce Marchand
Telephone Number 936-634-5515
Fax Number 936-634-5518
E-mail Address bmarchandpineywoodsacademyorg
Charter Holder Board Chair Contact Information
Charter Holder Board Dr Neal Naranjo
Chairs Name
Telephone Number 936-634-7979
Fax Number 936-634-7967
E-mail Address asdfnealgmailcom
Application Preparers Contact Information
Contact Name Bruce Marchand
Telephone Number 936-634-5515
Fax Number 936-634-5518
E-mail Address bmarchandpineywoodsacademyorg
Charter School Website
Web address wwwpineywoodsacademyorg
Page 7
Section III Posting of Adopted Budget
Chapter 12 of the Texas Education Code (TEC) specifically sect12104(b)(2)(E) makes explicit that open-enrollment
charters are required to comply with TEC Chapter 39 Subchapter D Financial Accountability TEC sect39084
titled Posting ofAdopted Budget states the following
(a) On final approval of the budget by the board of trustees the school district shall post on the districts Internet
website a copy of the budget adopted by the board of trustees The districts Internet website must prominently
display the electronic link to the adopted budget
(b) The district shall maintain the adopted budget on the districts Internet website until the third anniversary of the
date the budget was adopted
Provide the web address of the adopted budgets
wwwpineywoodsacademyorgaboutbudget
Page 8
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 9
Attachment1
Pineywoods Community Academy
Administrative Position Organizational Chart
Superintendent Elementary Principals
Secondary Principal (Grades 7-12 )
PARAMUS ECHS Principal (9-12)
Elementary Assistant Principal
Special Education Director
Director of Business Operations
Business Manager
Food Service Director
Technology Director
Updated March 2013
Bruce Marchand
Monica Gunter
Merilyn Session
Delbert Murphy
Keri Burton
George Fowler
Tina May
Jim McLeod
Steve Horrocks
Attachment 1A
PCA Board of DirectorsPCA Parents LufkinAngelina County Community1
PCA Executive DirectorSuperintendent]
Director of Business Operations Elem Asst Principal ECHS Principal Secondary Principal
Food Service Director Food Service Staff
Technology Director
Business Manager
Elementary REIMS Clerk
econdary REIMS Clerk
Building Manager Custodians
Elementary Teachers Sebpndary Teaches
Special Education Director
Nurse
dministrative Assistant High School Counselor
Bus Driver
structional Paraprofessionals Day Care Coordinator
School Counselor
Note 1) Director conducts performance appraisals of elementary teachers and elementary special education and intervention teachers
2) Secondary Principal conducts performance appraisals of secondary teachers and secondary special education teachers
3) Supervision and evaluation of Technology Director and PEIMS Clerks is the shared responsibility of the Director of Business Operations Director and Secondary Principal
Revised September 2012
Attachment 2
Not applicable - there are no other entities under the direction of the charter board
REVISED DURING CONTINGENCY PROCESS SEEINSERT
Section V Admission
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadlinefor the submission ofapplicationsfor admission
Beginning of Period End of Period (MonthDay) (MonthDay)
January 2 (or first day of school afterj March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013 q
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One p Yes
(bull No
C Not applicable (because lotteries are not utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
S- 3 1
V D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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 afirst-come first-served admission process when oversubscribed topublish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
Type Below
Page 10
APPROVED DURING CONTINGENCYPROCESS
Section V Admissi
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charier school establish a reasonable application deadlinefor the submission of applicationsfor admission
Beginning of Period End of Period
(MonthDay) (MonthDay)
January 2 (or first day of school afteM March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One 0Yes
No
C Not applicable (because lotteries arenot utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
Students who are currently enrolled and return the Notice of Intent to Return form prior to April Is indicating they wish tocontinue enrollment at PCA are considered enrolled and exempt from an enrollment lottery it the number of applicants exceeds the number of available seats at a grade level In addition any siblings of currently enrolled studentsare given priority in admission to fill any available slots If more than one student at a grade level on the waiting list has a sibling attending PCA a drawing will be heldbetween the eligible siblings todetermine admission
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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
regwres a cAwer scroo W uses proceM Wien overjwkcrifW to a
notice in a newspaper of general circulation not later than the seventh day before the application deadline Type Below
Page 10
F If the school has a separate process for re-enrollment state the process and the timeline to be used
Type Below
Students currently enrolled in Pineywoods Community Academy will receive a Notice of Intent to Return form in early January Parents are to notify the school in writing through the return of the form no later than the last day of January if they intend for their child to attend Pineywoods Community Academy for the next school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currentlyenrolled student without an NIR will be removed from enrollment roster on the last day of March in order to make room for new enrollees Parents who do not return an NIR will be contacted to verify that they do not intend to enroll their student in PCA for the following year
G State the procedures for processing applications received once the application deadline has passed
Type Below
Applications received after the open enrollment date will be processed based on the date received and placed after the names of students chosen by lottery whose applications were received by the open enrollment deadline
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 beprecludedfrom enrolling due to the charter schoolsfailure to receive information requiredfor enrollmentfrom the students parent or guardian orprevious school See TEC sect25002 Type Below
Applicants are required to fill out an enrollment form and must provide current immunization information a birth certificate a copy of the social security card if available and a copy of the parents drivers license Students are not required to provide copies of transcripts or other academic records and 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
I The charter holder certifies that the non-discrimination statement required by TEC sect12111(a)(6) is printed in the schools admission policy TEC sect12111(6) requires that a charter schools admission policy include astatement 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
Check One (gtYes
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories of a criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC sect 12111(a)(6) Check Oneshy
^ Yes ( The school excludes such students or reserves the right to exclude such students from admissions)
pNo (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bull as Attachment 3 a current copy of the admission policy that incorporates the information provided in the aboveahswers to questions A through H and any other relevant information
bull as Attachment 4 a blank copy of the current admission application (ie the information requested when the student first seeks admission) and
bull as Attachment 5 a blank copy of the current enrollment form(s) (ie the information required once an applicant has been offered admission and is registering for enrollment)
Page 11
Attachment 3
Admissions Policy
2013-2014 Admissions Procedure Timeline
Students currently enrolled in Pineywoods Community Academy will receive a Notice ofIntent to Return form in early January Parents are to notify the school in writing through the return of the form no later than Wednesday January 16th 2013 if they intend for their child to attend Pineywoods Community Academy for the 2013-2014 school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currently enrolled student without an NIR will be removed from the 2013-2014 enrollment roster on March 29th 2013 in order to make room for new enrollees
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted during the week of April 1st 2013
During the lottery a name is drawn for each vacancy that is available Each eligible applicants name drawn will be offered admission into Pineywoods Community Academy to fill spaces in that grade level Once available spaces are exhausted the remaining names drawn are placed on a waiting list in the order that the names are drawn PCA will begin notifying accepted applicants during the week of April 8th 2013 Students admitted into the school will be notified as well as students who are placed on a waiting list
If an additional vacancy occurs before the start of school or during the school year the student with the lowest number on the waiting list will be offered enrollment and that name will be removed from the waiting list If an application is received after the enrollment period the applicants name will be placed on the waiting list in the order the application is received In order to accommodate our families if more than one student on the waiting list has a sibling attending PCA a drawing will be held between the eligible siblings to determine admission
Pineywoods Academy does not discriminate on acceptance into the school based on gender national origin ethnicity religion disability academics artistic or athletic ability or the district the child would otherwise attend
Pineywoods Academy may choose to deny admission to students with a documented history of criminal offense juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111(a)(6)
This policy can be accessed from the PCA website at
httpwwwpineywoodsacademyorgadmissionspolicy
eiA Attachment 4 spoundf
AsSfr com
m Student Enrollment Application ypOr 1Pineywoods Community Academy Charter School
2013-2014 School Year
5WshyVS
H
DATE Completed_
Student Information
Students LegalName First Middle Last (as listed on birth certificate)
Gender malefemale Birth date (mdy)_ _ Birth City_ Birth State
Birth Country_ Grade Level for 2013-2014
Is this a repeatgrade YN
Students Street Address_
City State
County_ _Zip_ _Social Security _
Mailing Address (if different from above)
Street City_ State Zip
School District ofResidence
Past EnrollmentDetails
Previous SchoolsAttended (most recentfirst)
School Name School Name
Address Address
City_ State _Zip_ City State _Zip_
Phone _Dates of Attendance Phone _Dates of Attendance
Last Grade Completed atthis school _Last Grade Completed at this school
This school was a Check one This school was a Check one Public School Public School Private SchoolNon-religious Affiliated Private School Non-religious Affiliated Private School Religious Affiliated Private SchoolReligious Affiliated Charter School Charter School Home School Home School School outside of the Country School outsideof the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParcntGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach acopy of thecourt order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applvine to attend PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A
as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (ISS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information provided on this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsificatioti of these recordsfor anypurpose may be prosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
Section II Contact Information
The persons listed below will be contacted by agency staff if there are issues to be resolved in any of the sections
Superintendent Contact Information
Superintendents Name Bruce Marchand
Telephone Number 936-634-5515
Fax Number 936-634-5518
E-mail Address bmarchandpineywoodsacademyorg
Charter Holder Board Chair Contact Information
Charter Holder Board Dr Neal Naranjo
Chairs Name
Telephone Number 936-634-7979
Fax Number 936-634-7967
E-mail Address asdfnealgmailcom
Application Preparers Contact Information
Contact Name Bruce Marchand
Telephone Number 936-634-5515
Fax Number 936-634-5518
E-mail Address bmarchandpineywoodsacademyorg
Charter School Website
Web address wwwpineywoodsacademyorg
Page 7
Section III Posting of Adopted Budget
Chapter 12 of the Texas Education Code (TEC) specifically sect12104(b)(2)(E) makes explicit that open-enrollment
charters are required to comply with TEC Chapter 39 Subchapter D Financial Accountability TEC sect39084
titled Posting ofAdopted Budget states the following
(a) On final approval of the budget by the board of trustees the school district shall post on the districts Internet
website a copy of the budget adopted by the board of trustees The districts Internet website must prominently
display the electronic link to the adopted budget
(b) The district shall maintain the adopted budget on the districts Internet website until the third anniversary of the
date the budget was adopted
Provide the web address of the adopted budgets
wwwpineywoodsacademyorgaboutbudget
Page 8
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 9
Attachment1
Pineywoods Community Academy
Administrative Position Organizational Chart
Superintendent Elementary Principals
Secondary Principal (Grades 7-12 )
PARAMUS ECHS Principal (9-12)
Elementary Assistant Principal
Special Education Director
Director of Business Operations
Business Manager
Food Service Director
Technology Director
Updated March 2013
Bruce Marchand
Monica Gunter
Merilyn Session
Delbert Murphy
Keri Burton
George Fowler
Tina May
Jim McLeod
Steve Horrocks
Attachment 1A
PCA Board of DirectorsPCA Parents LufkinAngelina County Community1
PCA Executive DirectorSuperintendent]
Director of Business Operations Elem Asst Principal ECHS Principal Secondary Principal
Food Service Director Food Service Staff
Technology Director
Business Manager
Elementary REIMS Clerk
econdary REIMS Clerk
Building Manager Custodians
Elementary Teachers Sebpndary Teaches
Special Education Director
Nurse
dministrative Assistant High School Counselor
Bus Driver
structional Paraprofessionals Day Care Coordinator
School Counselor
Note 1) Director conducts performance appraisals of elementary teachers and elementary special education and intervention teachers
2) Secondary Principal conducts performance appraisals of secondary teachers and secondary special education teachers
3) Supervision and evaluation of Technology Director and PEIMS Clerks is the shared responsibility of the Director of Business Operations Director and Secondary Principal
Revised September 2012
Attachment 2
Not applicable - there are no other entities under the direction of the charter board
REVISED DURING CONTINGENCY PROCESS SEEINSERT
Section V Admission
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadlinefor the submission ofapplicationsfor admission
Beginning of Period End of Period (MonthDay) (MonthDay)
January 2 (or first day of school afterj March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013 q
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One p Yes
(bull No
C Not applicable (because lotteries are not utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
S- 3 1
V D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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 afirst-come first-served admission process when oversubscribed topublish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
Type Below
Page 10
APPROVED DURING CONTINGENCYPROCESS
Section V Admissi
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charier school establish a reasonable application deadlinefor the submission of applicationsfor admission
Beginning of Period End of Period
(MonthDay) (MonthDay)
January 2 (or first day of school afteM March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One 0Yes
No
C Not applicable (because lotteries arenot utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
Students who are currently enrolled and return the Notice of Intent to Return form prior to April Is indicating they wish tocontinue enrollment at PCA are considered enrolled and exempt from an enrollment lottery it the number of applicants exceeds the number of available seats at a grade level In addition any siblings of currently enrolled studentsare given priority in admission to fill any available slots If more than one student at a grade level on the waiting list has a sibling attending PCA a drawing will be heldbetween the eligible siblings todetermine admission
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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
regwres a cAwer scroo W uses proceM Wien overjwkcrifW to a
notice in a newspaper of general circulation not later than the seventh day before the application deadline Type Below
Page 10
F If the school has a separate process for re-enrollment state the process and the timeline to be used
Type Below
Students currently enrolled in Pineywoods Community Academy will receive a Notice of Intent to Return form in early January Parents are to notify the school in writing through the return of the form no later than the last day of January if they intend for their child to attend Pineywoods Community Academy for the next school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currentlyenrolled student without an NIR will be removed from enrollment roster on the last day of March in order to make room for new enrollees Parents who do not return an NIR will be contacted to verify that they do not intend to enroll their student in PCA for the following year
G State the procedures for processing applications received once the application deadline has passed
Type Below
Applications received after the open enrollment date will be processed based on the date received and placed after the names of students chosen by lottery whose applications were received by the open enrollment deadline
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 beprecludedfrom enrolling due to the charter schoolsfailure to receive information requiredfor enrollmentfrom the students parent or guardian orprevious school See TEC sect25002 Type Below
Applicants are required to fill out an enrollment form and must provide current immunization information a birth certificate a copy of the social security card if available and a copy of the parents drivers license Students are not required to provide copies of transcripts or other academic records and 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
I The charter holder certifies that the non-discrimination statement required by TEC sect12111(a)(6) is printed in the schools admission policy TEC sect12111(6) requires that a charter schools admission policy include astatement 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
Check One (gtYes
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories of a criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC sect 12111(a)(6) Check Oneshy
^ Yes ( The school excludes such students or reserves the right to exclude such students from admissions)
pNo (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bull as Attachment 3 a current copy of the admission policy that incorporates the information provided in the aboveahswers to questions A through H and any other relevant information
bull as Attachment 4 a blank copy of the current admission application (ie the information requested when the student first seeks admission) and
bull as Attachment 5 a blank copy of the current enrollment form(s) (ie the information required once an applicant has been offered admission and is registering for enrollment)
Page 11
Attachment 3
Admissions Policy
2013-2014 Admissions Procedure Timeline
Students currently enrolled in Pineywoods Community Academy will receive a Notice ofIntent to Return form in early January Parents are to notify the school in writing through the return of the form no later than Wednesday January 16th 2013 if they intend for their child to attend Pineywoods Community Academy for the 2013-2014 school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currently enrolled student without an NIR will be removed from the 2013-2014 enrollment roster on March 29th 2013 in order to make room for new enrollees
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted during the week of April 1st 2013
During the lottery a name is drawn for each vacancy that is available Each eligible applicants name drawn will be offered admission into Pineywoods Community Academy to fill spaces in that grade level Once available spaces are exhausted the remaining names drawn are placed on a waiting list in the order that the names are drawn PCA will begin notifying accepted applicants during the week of April 8th 2013 Students admitted into the school will be notified as well as students who are placed on a waiting list
If an additional vacancy occurs before the start of school or during the school year the student with the lowest number on the waiting list will be offered enrollment and that name will be removed from the waiting list If an application is received after the enrollment period the applicants name will be placed on the waiting list in the order the application is received In order to accommodate our families if more than one student on the waiting list has a sibling attending PCA a drawing will be held between the eligible siblings to determine admission
Pineywoods Academy does not discriminate on acceptance into the school based on gender national origin ethnicity religion disability academics artistic or athletic ability or the district the child would otherwise attend
Pineywoods Academy may choose to deny admission to students with a documented history of criminal offense juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111(a)(6)
This policy can be accessed from the PCA website at
httpwwwpineywoodsacademyorgadmissionspolicy
eiA Attachment 4 spoundf
AsSfr com
m Student Enrollment Application ypOr 1Pineywoods Community Academy Charter School
2013-2014 School Year
5WshyVS
H
DATE Completed_
Student Information
Students LegalName First Middle Last (as listed on birth certificate)
Gender malefemale Birth date (mdy)_ _ Birth City_ Birth State
Birth Country_ Grade Level for 2013-2014
Is this a repeatgrade YN
Students Street Address_
City State
County_ _Zip_ _Social Security _
Mailing Address (if different from above)
Street City_ State Zip
School District ofResidence
Past EnrollmentDetails
Previous SchoolsAttended (most recentfirst)
School Name School Name
Address Address
City_ State _Zip_ City State _Zip_
Phone _Dates of Attendance Phone _Dates of Attendance
Last Grade Completed atthis school _Last Grade Completed at this school
This school was a Check one This school was a Check one Public School Public School Private SchoolNon-religious Affiliated Private School Non-religious Affiliated Private School Religious Affiliated Private SchoolReligious Affiliated Charter School Charter School Home School Home School School outside of the Country School outsideof the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParcntGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach acopy of thecourt order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applvine to attend PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A
as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (ISS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information provided on this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsificatioti of these recordsfor anypurpose may be prosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
Section III Posting of Adopted Budget
Chapter 12 of the Texas Education Code (TEC) specifically sect12104(b)(2)(E) makes explicit that open-enrollment
charters are required to comply with TEC Chapter 39 Subchapter D Financial Accountability TEC sect39084
titled Posting ofAdopted Budget states the following
(a) On final approval of the budget by the board of trustees the school district shall post on the districts Internet
website a copy of the budget adopted by the board of trustees The districts Internet website must prominently
display the electronic link to the adopted budget
(b) The district shall maintain the adopted budget on the districts Internet website until the third anniversary of the
date the budget was adopted
Provide the web address of the adopted budgets
wwwpineywoodsacademyorgaboutbudget
Page 8
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 9
Attachment1
Pineywoods Community Academy
Administrative Position Organizational Chart
Superintendent Elementary Principals
Secondary Principal (Grades 7-12 )
PARAMUS ECHS Principal (9-12)
Elementary Assistant Principal
Special Education Director
Director of Business Operations
Business Manager
Food Service Director
Technology Director
Updated March 2013
Bruce Marchand
Monica Gunter
Merilyn Session
Delbert Murphy
Keri Burton
George Fowler
Tina May
Jim McLeod
Steve Horrocks
Attachment 1A
PCA Board of DirectorsPCA Parents LufkinAngelina County Community1
PCA Executive DirectorSuperintendent]
Director of Business Operations Elem Asst Principal ECHS Principal Secondary Principal
Food Service Director Food Service Staff
Technology Director
Business Manager
Elementary REIMS Clerk
econdary REIMS Clerk
Building Manager Custodians
Elementary Teachers Sebpndary Teaches
Special Education Director
Nurse
dministrative Assistant High School Counselor
Bus Driver
structional Paraprofessionals Day Care Coordinator
School Counselor
Note 1) Director conducts performance appraisals of elementary teachers and elementary special education and intervention teachers
2) Secondary Principal conducts performance appraisals of secondary teachers and secondary special education teachers
3) Supervision and evaluation of Technology Director and PEIMS Clerks is the shared responsibility of the Director of Business Operations Director and Secondary Principal
Revised September 2012
Attachment 2
Not applicable - there are no other entities under the direction of the charter board
REVISED DURING CONTINGENCY PROCESS SEEINSERT
Section V Admission
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadlinefor the submission ofapplicationsfor admission
Beginning of Period End of Period (MonthDay) (MonthDay)
January 2 (or first day of school afterj March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013 q
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One p Yes
(bull No
C Not applicable (because lotteries are not utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
S- 3 1
V D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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 afirst-come first-served admission process when oversubscribed topublish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
Type Below
Page 10
APPROVED DURING CONTINGENCYPROCESS
Section V Admissi
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charier school establish a reasonable application deadlinefor the submission of applicationsfor admission
Beginning of Period End of Period
(MonthDay) (MonthDay)
January 2 (or first day of school afteM March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One 0Yes
No
C Not applicable (because lotteries arenot utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
Students who are currently enrolled and return the Notice of Intent to Return form prior to April Is indicating they wish tocontinue enrollment at PCA are considered enrolled and exempt from an enrollment lottery it the number of applicants exceeds the number of available seats at a grade level In addition any siblings of currently enrolled studentsare given priority in admission to fill any available slots If more than one student at a grade level on the waiting list has a sibling attending PCA a drawing will be heldbetween the eligible siblings todetermine admission
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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
regwres a cAwer scroo W uses proceM Wien overjwkcrifW to a
notice in a newspaper of general circulation not later than the seventh day before the application deadline Type Below
Page 10
F If the school has a separate process for re-enrollment state the process and the timeline to be used
Type Below
Students currently enrolled in Pineywoods Community Academy will receive a Notice of Intent to Return form in early January Parents are to notify the school in writing through the return of the form no later than the last day of January if they intend for their child to attend Pineywoods Community Academy for the next school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currentlyenrolled student without an NIR will be removed from enrollment roster on the last day of March in order to make room for new enrollees Parents who do not return an NIR will be contacted to verify that they do not intend to enroll their student in PCA for the following year
G State the procedures for processing applications received once the application deadline has passed
Type Below
Applications received after the open enrollment date will be processed based on the date received and placed after the names of students chosen by lottery whose applications were received by the open enrollment deadline
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 beprecludedfrom enrolling due to the charter schoolsfailure to receive information requiredfor enrollmentfrom the students parent or guardian orprevious school See TEC sect25002 Type Below
Applicants are required to fill out an enrollment form and must provide current immunization information a birth certificate a copy of the social security card if available and a copy of the parents drivers license Students are not required to provide copies of transcripts or other academic records and 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
I The charter holder certifies that the non-discrimination statement required by TEC sect12111(a)(6) is printed in the schools admission policy TEC sect12111(6) requires that a charter schools admission policy include astatement 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
Check One (gtYes
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories of a criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC sect 12111(a)(6) Check Oneshy
^ Yes ( The school excludes such students or reserves the right to exclude such students from admissions)
pNo (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bull as Attachment 3 a current copy of the admission policy that incorporates the information provided in the aboveahswers to questions A through H and any other relevant information
bull as Attachment 4 a blank copy of the current admission application (ie the information requested when the student first seeks admission) and
bull as Attachment 5 a blank copy of the current enrollment form(s) (ie the information required once an applicant has been offered admission and is registering for enrollment)
Page 11
Attachment 3
Admissions Policy
2013-2014 Admissions Procedure Timeline
Students currently enrolled in Pineywoods Community Academy will receive a Notice ofIntent to Return form in early January Parents are to notify the school in writing through the return of the form no later than Wednesday January 16th 2013 if they intend for their child to attend Pineywoods Community Academy for the 2013-2014 school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currently enrolled student without an NIR will be removed from the 2013-2014 enrollment roster on March 29th 2013 in order to make room for new enrollees
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted during the week of April 1st 2013
During the lottery a name is drawn for each vacancy that is available Each eligible applicants name drawn will be offered admission into Pineywoods Community Academy to fill spaces in that grade level Once available spaces are exhausted the remaining names drawn are placed on a waiting list in the order that the names are drawn PCA will begin notifying accepted applicants during the week of April 8th 2013 Students admitted into the school will be notified as well as students who are placed on a waiting list
If an additional vacancy occurs before the start of school or during the school year the student with the lowest number on the waiting list will be offered enrollment and that name will be removed from the waiting list If an application is received after the enrollment period the applicants name will be placed on the waiting list in the order the application is received In order to accommodate our families if more than one student on the waiting list has a sibling attending PCA a drawing will be held between the eligible siblings to determine admission
Pineywoods Academy does not discriminate on acceptance into the school based on gender national origin ethnicity religion disability academics artistic or athletic ability or the district the child would otherwise attend
Pineywoods Academy may choose to deny admission to students with a documented history of criminal offense juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111(a)(6)
This policy can be accessed from the PCA website at
httpwwwpineywoodsacademyorgadmissionspolicy
eiA Attachment 4 spoundf
AsSfr com
m Student Enrollment Application ypOr 1Pineywoods Community Academy Charter School
2013-2014 School Year
5WshyVS
H
DATE Completed_
Student Information
Students LegalName First Middle Last (as listed on birth certificate)
Gender malefemale Birth date (mdy)_ _ Birth City_ Birth State
Birth Country_ Grade Level for 2013-2014
Is this a repeatgrade YN
Students Street Address_
City State
County_ _Zip_ _Social Security _
Mailing Address (if different from above)
Street City_ State Zip
School District ofResidence
Past EnrollmentDetails
Previous SchoolsAttended (most recentfirst)
School Name School Name
Address Address
City_ State _Zip_ City State _Zip_
Phone _Dates of Attendance Phone _Dates of Attendance
Last Grade Completed atthis school _Last Grade Completed at this school
This school was a Check one This school was a Check one Public School Public School Private SchoolNon-religious Affiliated Private School Non-religious Affiliated Private School Religious Affiliated Private SchoolReligious Affiliated Charter School Charter School Home School Home School School outside of the Country School outsideof the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParcntGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach acopy of thecourt order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applvine to attend PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A
as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (ISS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information provided on this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsificatioti of these recordsfor anypurpose may be prosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
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 9
Attachment1
Pineywoods Community Academy
Administrative Position Organizational Chart
Superintendent Elementary Principals
Secondary Principal (Grades 7-12 )
PARAMUS ECHS Principal (9-12)
Elementary Assistant Principal
Special Education Director
Director of Business Operations
Business Manager
Food Service Director
Technology Director
Updated March 2013
Bruce Marchand
Monica Gunter
Merilyn Session
Delbert Murphy
Keri Burton
George Fowler
Tina May
Jim McLeod
Steve Horrocks
Attachment 1A
PCA Board of DirectorsPCA Parents LufkinAngelina County Community1
PCA Executive DirectorSuperintendent]
Director of Business Operations Elem Asst Principal ECHS Principal Secondary Principal
Food Service Director Food Service Staff
Technology Director
Business Manager
Elementary REIMS Clerk
econdary REIMS Clerk
Building Manager Custodians
Elementary Teachers Sebpndary Teaches
Special Education Director
Nurse
dministrative Assistant High School Counselor
Bus Driver
structional Paraprofessionals Day Care Coordinator
School Counselor
Note 1) Director conducts performance appraisals of elementary teachers and elementary special education and intervention teachers
2) Secondary Principal conducts performance appraisals of secondary teachers and secondary special education teachers
3) Supervision and evaluation of Technology Director and PEIMS Clerks is the shared responsibility of the Director of Business Operations Director and Secondary Principal
Revised September 2012
Attachment 2
Not applicable - there are no other entities under the direction of the charter board
REVISED DURING CONTINGENCY PROCESS SEEINSERT
Section V Admission
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadlinefor the submission ofapplicationsfor admission
Beginning of Period End of Period (MonthDay) (MonthDay)
January 2 (or first day of school afterj March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013 q
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One p Yes
(bull No
C Not applicable (because lotteries are not utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
S- 3 1
V D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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 afirst-come first-served admission process when oversubscribed topublish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
Type Below
Page 10
APPROVED DURING CONTINGENCYPROCESS
Section V Admissi
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charier school establish a reasonable application deadlinefor the submission of applicationsfor admission
Beginning of Period End of Period
(MonthDay) (MonthDay)
January 2 (or first day of school afteM March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One 0Yes
No
C Not applicable (because lotteries arenot utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
Students who are currently enrolled and return the Notice of Intent to Return form prior to April Is indicating they wish tocontinue enrollment at PCA are considered enrolled and exempt from an enrollment lottery it the number of applicants exceeds the number of available seats at a grade level In addition any siblings of currently enrolled studentsare given priority in admission to fill any available slots If more than one student at a grade level on the waiting list has a sibling attending PCA a drawing will be heldbetween the eligible siblings todetermine admission
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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
regwres a cAwer scroo W uses proceM Wien overjwkcrifW to a
notice in a newspaper of general circulation not later than the seventh day before the application deadline Type Below
Page 10
F If the school has a separate process for re-enrollment state the process and the timeline to be used
Type Below
Students currently enrolled in Pineywoods Community Academy will receive a Notice of Intent to Return form in early January Parents are to notify the school in writing through the return of the form no later than the last day of January if they intend for their child to attend Pineywoods Community Academy for the next school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currentlyenrolled student without an NIR will be removed from enrollment roster on the last day of March in order to make room for new enrollees Parents who do not return an NIR will be contacted to verify that they do not intend to enroll their student in PCA for the following year
G State the procedures for processing applications received once the application deadline has passed
Type Below
Applications received after the open enrollment date will be processed based on the date received and placed after the names of students chosen by lottery whose applications were received by the open enrollment deadline
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 beprecludedfrom enrolling due to the charter schoolsfailure to receive information requiredfor enrollmentfrom the students parent or guardian orprevious school See TEC sect25002 Type Below
Applicants are required to fill out an enrollment form and must provide current immunization information a birth certificate a copy of the social security card if available and a copy of the parents drivers license Students are not required to provide copies of transcripts or other academic records and 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
I The charter holder certifies that the non-discrimination statement required by TEC sect12111(a)(6) is printed in the schools admission policy TEC sect12111(6) requires that a charter schools admission policy include astatement 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
Check One (gtYes
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories of a criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC sect 12111(a)(6) Check Oneshy
^ Yes ( The school excludes such students or reserves the right to exclude such students from admissions)
pNo (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bull as Attachment 3 a current copy of the admission policy that incorporates the information provided in the aboveahswers to questions A through H and any other relevant information
bull as Attachment 4 a blank copy of the current admission application (ie the information requested when the student first seeks admission) and
bull as Attachment 5 a blank copy of the current enrollment form(s) (ie the information required once an applicant has been offered admission and is registering for enrollment)
Page 11
Attachment 3
Admissions Policy
2013-2014 Admissions Procedure Timeline
Students currently enrolled in Pineywoods Community Academy will receive a Notice ofIntent to Return form in early January Parents are to notify the school in writing through the return of the form no later than Wednesday January 16th 2013 if they intend for their child to attend Pineywoods Community Academy for the 2013-2014 school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currently enrolled student without an NIR will be removed from the 2013-2014 enrollment roster on March 29th 2013 in order to make room for new enrollees
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted during the week of April 1st 2013
During the lottery a name is drawn for each vacancy that is available Each eligible applicants name drawn will be offered admission into Pineywoods Community Academy to fill spaces in that grade level Once available spaces are exhausted the remaining names drawn are placed on a waiting list in the order that the names are drawn PCA will begin notifying accepted applicants during the week of April 8th 2013 Students admitted into the school will be notified as well as students who are placed on a waiting list
If an additional vacancy occurs before the start of school or during the school year the student with the lowest number on the waiting list will be offered enrollment and that name will be removed from the waiting list If an application is received after the enrollment period the applicants name will be placed on the waiting list in the order the application is received In order to accommodate our families if more than one student on the waiting list has a sibling attending PCA a drawing will be held between the eligible siblings to determine admission
Pineywoods Academy does not discriminate on acceptance into the school based on gender national origin ethnicity religion disability academics artistic or athletic ability or the district the child would otherwise attend
Pineywoods Academy may choose to deny admission to students with a documented history of criminal offense juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111(a)(6)
This policy can be accessed from the PCA website at
httpwwwpineywoodsacademyorgadmissionspolicy
eiA Attachment 4 spoundf
AsSfr com
m Student Enrollment Application ypOr 1Pineywoods Community Academy Charter School
2013-2014 School Year
5WshyVS
H
DATE Completed_
Student Information
Students LegalName First Middle Last (as listed on birth certificate)
Gender malefemale Birth date (mdy)_ _ Birth City_ Birth State
Birth Country_ Grade Level for 2013-2014
Is this a repeatgrade YN
Students Street Address_
City State
County_ _Zip_ _Social Security _
Mailing Address (if different from above)
Street City_ State Zip
School District ofResidence
Past EnrollmentDetails
Previous SchoolsAttended (most recentfirst)
School Name School Name
Address Address
City_ State _Zip_ City State _Zip_
Phone _Dates of Attendance Phone _Dates of Attendance
Last Grade Completed atthis school _Last Grade Completed at this school
This school was a Check one This school was a Check one Public School Public School Private SchoolNon-religious Affiliated Private School Non-religious Affiliated Private School Religious Affiliated Private SchoolReligious Affiliated Charter School Charter School Home School Home School School outside of the Country School outsideof the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParcntGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach acopy of thecourt order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applvine to attend PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A
as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (ISS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information provided on this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsificatioti of these recordsfor anypurpose may be prosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
Attachment1
Pineywoods Community Academy
Administrative Position Organizational Chart
Superintendent Elementary Principals
Secondary Principal (Grades 7-12 )
PARAMUS ECHS Principal (9-12)
Elementary Assistant Principal
Special Education Director
Director of Business Operations
Business Manager
Food Service Director
Technology Director
Updated March 2013
Bruce Marchand
Monica Gunter
Merilyn Session
Delbert Murphy
Keri Burton
George Fowler
Tina May
Jim McLeod
Steve Horrocks
Attachment 1A
PCA Board of DirectorsPCA Parents LufkinAngelina County Community1
PCA Executive DirectorSuperintendent]
Director of Business Operations Elem Asst Principal ECHS Principal Secondary Principal
Food Service Director Food Service Staff
Technology Director
Business Manager
Elementary REIMS Clerk
econdary REIMS Clerk
Building Manager Custodians
Elementary Teachers Sebpndary Teaches
Special Education Director
Nurse
dministrative Assistant High School Counselor
Bus Driver
structional Paraprofessionals Day Care Coordinator
School Counselor
Note 1) Director conducts performance appraisals of elementary teachers and elementary special education and intervention teachers
2) Secondary Principal conducts performance appraisals of secondary teachers and secondary special education teachers
3) Supervision and evaluation of Technology Director and PEIMS Clerks is the shared responsibility of the Director of Business Operations Director and Secondary Principal
Revised September 2012
Attachment 2
Not applicable - there are no other entities under the direction of the charter board
REVISED DURING CONTINGENCY PROCESS SEEINSERT
Section V Admission
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadlinefor the submission ofapplicationsfor admission
Beginning of Period End of Period (MonthDay) (MonthDay)
January 2 (or first day of school afterj March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013 q
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One p Yes
(bull No
C Not applicable (because lotteries are not utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
S- 3 1
V D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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 afirst-come first-served admission process when oversubscribed topublish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
Type Below
Page 10
APPROVED DURING CONTINGENCYPROCESS
Section V Admissi
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charier school establish a reasonable application deadlinefor the submission of applicationsfor admission
Beginning of Period End of Period
(MonthDay) (MonthDay)
January 2 (or first day of school afteM March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One 0Yes
No
C Not applicable (because lotteries arenot utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
Students who are currently enrolled and return the Notice of Intent to Return form prior to April Is indicating they wish tocontinue enrollment at PCA are considered enrolled and exempt from an enrollment lottery it the number of applicants exceeds the number of available seats at a grade level In addition any siblings of currently enrolled studentsare given priority in admission to fill any available slots If more than one student at a grade level on the waiting list has a sibling attending PCA a drawing will be heldbetween the eligible siblings todetermine admission
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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
regwres a cAwer scroo W uses proceM Wien overjwkcrifW to a
notice in a newspaper of general circulation not later than the seventh day before the application deadline Type Below
Page 10
F If the school has a separate process for re-enrollment state the process and the timeline to be used
Type Below
Students currently enrolled in Pineywoods Community Academy will receive a Notice of Intent to Return form in early January Parents are to notify the school in writing through the return of the form no later than the last day of January if they intend for their child to attend Pineywoods Community Academy for the next school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currentlyenrolled student without an NIR will be removed from enrollment roster on the last day of March in order to make room for new enrollees Parents who do not return an NIR will be contacted to verify that they do not intend to enroll their student in PCA for the following year
G State the procedures for processing applications received once the application deadline has passed
Type Below
Applications received after the open enrollment date will be processed based on the date received and placed after the names of students chosen by lottery whose applications were received by the open enrollment deadline
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 beprecludedfrom enrolling due to the charter schoolsfailure to receive information requiredfor enrollmentfrom the students parent or guardian orprevious school See TEC sect25002 Type Below
Applicants are required to fill out an enrollment form and must provide current immunization information a birth certificate a copy of the social security card if available and a copy of the parents drivers license Students are not required to provide copies of transcripts or other academic records and 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
I The charter holder certifies that the non-discrimination statement required by TEC sect12111(a)(6) is printed in the schools admission policy TEC sect12111(6) requires that a charter schools admission policy include astatement 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
Check One (gtYes
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories of a criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC sect 12111(a)(6) Check Oneshy
^ Yes ( The school excludes such students or reserves the right to exclude such students from admissions)
pNo (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bull as Attachment 3 a current copy of the admission policy that incorporates the information provided in the aboveahswers to questions A through H and any other relevant information
bull as Attachment 4 a blank copy of the current admission application (ie the information requested when the student first seeks admission) and
bull as Attachment 5 a blank copy of the current enrollment form(s) (ie the information required once an applicant has been offered admission and is registering for enrollment)
Page 11
Attachment 3
Admissions Policy
2013-2014 Admissions Procedure Timeline
Students currently enrolled in Pineywoods Community Academy will receive a Notice ofIntent to Return form in early January Parents are to notify the school in writing through the return of the form no later than Wednesday January 16th 2013 if they intend for their child to attend Pineywoods Community Academy for the 2013-2014 school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currently enrolled student without an NIR will be removed from the 2013-2014 enrollment roster on March 29th 2013 in order to make room for new enrollees
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted during the week of April 1st 2013
During the lottery a name is drawn for each vacancy that is available Each eligible applicants name drawn will be offered admission into Pineywoods Community Academy to fill spaces in that grade level Once available spaces are exhausted the remaining names drawn are placed on a waiting list in the order that the names are drawn PCA will begin notifying accepted applicants during the week of April 8th 2013 Students admitted into the school will be notified as well as students who are placed on a waiting list
If an additional vacancy occurs before the start of school or during the school year the student with the lowest number on the waiting list will be offered enrollment and that name will be removed from the waiting list If an application is received after the enrollment period the applicants name will be placed on the waiting list in the order the application is received In order to accommodate our families if more than one student on the waiting list has a sibling attending PCA a drawing will be held between the eligible siblings to determine admission
Pineywoods Academy does not discriminate on acceptance into the school based on gender national origin ethnicity religion disability academics artistic or athletic ability or the district the child would otherwise attend
Pineywoods Academy may choose to deny admission to students with a documented history of criminal offense juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111(a)(6)
This policy can be accessed from the PCA website at
httpwwwpineywoodsacademyorgadmissionspolicy
eiA Attachment 4 spoundf
AsSfr com
m Student Enrollment Application ypOr 1Pineywoods Community Academy Charter School
2013-2014 School Year
5WshyVS
H
DATE Completed_
Student Information
Students LegalName First Middle Last (as listed on birth certificate)
Gender malefemale Birth date (mdy)_ _ Birth City_ Birth State
Birth Country_ Grade Level for 2013-2014
Is this a repeatgrade YN
Students Street Address_
City State
County_ _Zip_ _Social Security _
Mailing Address (if different from above)
Street City_ State Zip
School District ofResidence
Past EnrollmentDetails
Previous SchoolsAttended (most recentfirst)
School Name School Name
Address Address
City_ State _Zip_ City State _Zip_
Phone _Dates of Attendance Phone _Dates of Attendance
Last Grade Completed atthis school _Last Grade Completed at this school
This school was a Check one This school was a Check one Public School Public School Private SchoolNon-religious Affiliated Private School Non-religious Affiliated Private School Religious Affiliated Private SchoolReligious Affiliated Charter School Charter School Home School Home School School outside of the Country School outsideof the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParcntGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach acopy of thecourt order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applvine to attend PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A
as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (ISS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information provided on this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsificatioti of these recordsfor anypurpose may be prosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
Attachment 1A
PCA Board of DirectorsPCA Parents LufkinAngelina County Community1
PCA Executive DirectorSuperintendent]
Director of Business Operations Elem Asst Principal ECHS Principal Secondary Principal
Food Service Director Food Service Staff
Technology Director
Business Manager
Elementary REIMS Clerk
econdary REIMS Clerk
Building Manager Custodians
Elementary Teachers Sebpndary Teaches
Special Education Director
Nurse
dministrative Assistant High School Counselor
Bus Driver
structional Paraprofessionals Day Care Coordinator
School Counselor
Note 1) Director conducts performance appraisals of elementary teachers and elementary special education and intervention teachers
2) Secondary Principal conducts performance appraisals of secondary teachers and secondary special education teachers
3) Supervision and evaluation of Technology Director and PEIMS Clerks is the shared responsibility of the Director of Business Operations Director and Secondary Principal
Revised September 2012
Attachment 2
Not applicable - there are no other entities under the direction of the charter board
REVISED DURING CONTINGENCY PROCESS SEEINSERT
Section V Admission
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadlinefor the submission ofapplicationsfor admission
Beginning of Period End of Period (MonthDay) (MonthDay)
January 2 (or first day of school afterj March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013 q
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One p Yes
(bull No
C Not applicable (because lotteries are not utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
S- 3 1
V D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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 afirst-come first-served admission process when oversubscribed topublish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
Type Below
Page 10
APPROVED DURING CONTINGENCYPROCESS
Section V Admissi
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charier school establish a reasonable application deadlinefor the submission of applicationsfor admission
Beginning of Period End of Period
(MonthDay) (MonthDay)
January 2 (or first day of school afteM March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One 0Yes
No
C Not applicable (because lotteries arenot utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
Students who are currently enrolled and return the Notice of Intent to Return form prior to April Is indicating they wish tocontinue enrollment at PCA are considered enrolled and exempt from an enrollment lottery it the number of applicants exceeds the number of available seats at a grade level In addition any siblings of currently enrolled studentsare given priority in admission to fill any available slots If more than one student at a grade level on the waiting list has a sibling attending PCA a drawing will be heldbetween the eligible siblings todetermine admission
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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
regwres a cAwer scroo W uses proceM Wien overjwkcrifW to a
notice in a newspaper of general circulation not later than the seventh day before the application deadline Type Below
Page 10
F If the school has a separate process for re-enrollment state the process and the timeline to be used
Type Below
Students currently enrolled in Pineywoods Community Academy will receive a Notice of Intent to Return form in early January Parents are to notify the school in writing through the return of the form no later than the last day of January if they intend for their child to attend Pineywoods Community Academy for the next school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currentlyenrolled student without an NIR will be removed from enrollment roster on the last day of March in order to make room for new enrollees Parents who do not return an NIR will be contacted to verify that they do not intend to enroll their student in PCA for the following year
G State the procedures for processing applications received once the application deadline has passed
Type Below
Applications received after the open enrollment date will be processed based on the date received and placed after the names of students chosen by lottery whose applications were received by the open enrollment deadline
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 beprecludedfrom enrolling due to the charter schoolsfailure to receive information requiredfor enrollmentfrom the students parent or guardian orprevious school See TEC sect25002 Type Below
Applicants are required to fill out an enrollment form and must provide current immunization information a birth certificate a copy of the social security card if available and a copy of the parents drivers license Students are not required to provide copies of transcripts or other academic records and 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
I The charter holder certifies that the non-discrimination statement required by TEC sect12111(a)(6) is printed in the schools admission policy TEC sect12111(6) requires that a charter schools admission policy include astatement 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
Check One (gtYes
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories of a criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC sect 12111(a)(6) Check Oneshy
^ Yes ( The school excludes such students or reserves the right to exclude such students from admissions)
pNo (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bull as Attachment 3 a current copy of the admission policy that incorporates the information provided in the aboveahswers to questions A through H and any other relevant information
bull as Attachment 4 a blank copy of the current admission application (ie the information requested when the student first seeks admission) and
bull as Attachment 5 a blank copy of the current enrollment form(s) (ie the information required once an applicant has been offered admission and is registering for enrollment)
Page 11
Attachment 3
Admissions Policy
2013-2014 Admissions Procedure Timeline
Students currently enrolled in Pineywoods Community Academy will receive a Notice ofIntent to Return form in early January Parents are to notify the school in writing through the return of the form no later than Wednesday January 16th 2013 if they intend for their child to attend Pineywoods Community Academy for the 2013-2014 school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currently enrolled student without an NIR will be removed from the 2013-2014 enrollment roster on March 29th 2013 in order to make room for new enrollees
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted during the week of April 1st 2013
During the lottery a name is drawn for each vacancy that is available Each eligible applicants name drawn will be offered admission into Pineywoods Community Academy to fill spaces in that grade level Once available spaces are exhausted the remaining names drawn are placed on a waiting list in the order that the names are drawn PCA will begin notifying accepted applicants during the week of April 8th 2013 Students admitted into the school will be notified as well as students who are placed on a waiting list
If an additional vacancy occurs before the start of school or during the school year the student with the lowest number on the waiting list will be offered enrollment and that name will be removed from the waiting list If an application is received after the enrollment period the applicants name will be placed on the waiting list in the order the application is received In order to accommodate our families if more than one student on the waiting list has a sibling attending PCA a drawing will be held between the eligible siblings to determine admission
Pineywoods Academy does not discriminate on acceptance into the school based on gender national origin ethnicity religion disability academics artistic or athletic ability or the district the child would otherwise attend
Pineywoods Academy may choose to deny admission to students with a documented history of criminal offense juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111(a)(6)
This policy can be accessed from the PCA website at
httpwwwpineywoodsacademyorgadmissionspolicy
eiA Attachment 4 spoundf
AsSfr com
m Student Enrollment Application ypOr 1Pineywoods Community Academy Charter School
2013-2014 School Year
5WshyVS
H
DATE Completed_
Student Information
Students LegalName First Middle Last (as listed on birth certificate)
Gender malefemale Birth date (mdy)_ _ Birth City_ Birth State
Birth Country_ Grade Level for 2013-2014
Is this a repeatgrade YN
Students Street Address_
City State
County_ _Zip_ _Social Security _
Mailing Address (if different from above)
Street City_ State Zip
School District ofResidence
Past EnrollmentDetails
Previous SchoolsAttended (most recentfirst)
School Name School Name
Address Address
City_ State _Zip_ City State _Zip_
Phone _Dates of Attendance Phone _Dates of Attendance
Last Grade Completed atthis school _Last Grade Completed at this school
This school was a Check one This school was a Check one Public School Public School Private SchoolNon-religious Affiliated Private School Non-religious Affiliated Private School Religious Affiliated Private SchoolReligious Affiliated Charter School Charter School Home School Home School School outside of the Country School outsideof the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParcntGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach acopy of thecourt order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applvine to attend PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A
as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (ISS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information provided on this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsificatioti of these recordsfor anypurpose may be prosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
Attachment 2
Not applicable - there are no other entities under the direction of the charter board
REVISED DURING CONTINGENCY PROCESS SEEINSERT
Section V Admission
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadlinefor the submission ofapplicationsfor admission
Beginning of Period End of Period (MonthDay) (MonthDay)
January 2 (or first day of school afterj March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013 q
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One p Yes
(bull No
C Not applicable (because lotteries are not utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
S- 3 1
V D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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 afirst-come first-served admission process when oversubscribed topublish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
Type Below
Page 10
APPROVED DURING CONTINGENCYPROCESS
Section V Admissi
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charier school establish a reasonable application deadlinefor the submission of applicationsfor admission
Beginning of Period End of Period
(MonthDay) (MonthDay)
January 2 (or first day of school afteM March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One 0Yes
No
C Not applicable (because lotteries arenot utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
Students who are currently enrolled and return the Notice of Intent to Return form prior to April Is indicating they wish tocontinue enrollment at PCA are considered enrolled and exempt from an enrollment lottery it the number of applicants exceeds the number of available seats at a grade level In addition any siblings of currently enrolled studentsare given priority in admission to fill any available slots If more than one student at a grade level on the waiting list has a sibling attending PCA a drawing will be heldbetween the eligible siblings todetermine admission
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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
regwres a cAwer scroo W uses proceM Wien overjwkcrifW to a
notice in a newspaper of general circulation not later than the seventh day before the application deadline Type Below
Page 10
F If the school has a separate process for re-enrollment state the process and the timeline to be used
Type Below
Students currently enrolled in Pineywoods Community Academy will receive a Notice of Intent to Return form in early January Parents are to notify the school in writing through the return of the form no later than the last day of January if they intend for their child to attend Pineywoods Community Academy for the next school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currentlyenrolled student without an NIR will be removed from enrollment roster on the last day of March in order to make room for new enrollees Parents who do not return an NIR will be contacted to verify that they do not intend to enroll their student in PCA for the following year
G State the procedures for processing applications received once the application deadline has passed
Type Below
Applications received after the open enrollment date will be processed based on the date received and placed after the names of students chosen by lottery whose applications were received by the open enrollment deadline
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 beprecludedfrom enrolling due to the charter schoolsfailure to receive information requiredfor enrollmentfrom the students parent or guardian orprevious school See TEC sect25002 Type Below
Applicants are required to fill out an enrollment form and must provide current immunization information a birth certificate a copy of the social security card if available and a copy of the parents drivers license Students are not required to provide copies of transcripts or other academic records and 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
I The charter holder certifies that the non-discrimination statement required by TEC sect12111(a)(6) is printed in the schools admission policy TEC sect12111(6) requires that a charter schools admission policy include astatement 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
Check One (gtYes
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories of a criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC sect 12111(a)(6) Check Oneshy
^ Yes ( The school excludes such students or reserves the right to exclude such students from admissions)
pNo (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bull as Attachment 3 a current copy of the admission policy that incorporates the information provided in the aboveahswers to questions A through H and any other relevant information
bull as Attachment 4 a blank copy of the current admission application (ie the information requested when the student first seeks admission) and
bull as Attachment 5 a blank copy of the current enrollment form(s) (ie the information required once an applicant has been offered admission and is registering for enrollment)
Page 11
Attachment 3
Admissions Policy
2013-2014 Admissions Procedure Timeline
Students currently enrolled in Pineywoods Community Academy will receive a Notice ofIntent to Return form in early January Parents are to notify the school in writing through the return of the form no later than Wednesday January 16th 2013 if they intend for their child to attend Pineywoods Community Academy for the 2013-2014 school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currently enrolled student without an NIR will be removed from the 2013-2014 enrollment roster on March 29th 2013 in order to make room for new enrollees
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted during the week of April 1st 2013
During the lottery a name is drawn for each vacancy that is available Each eligible applicants name drawn will be offered admission into Pineywoods Community Academy to fill spaces in that grade level Once available spaces are exhausted the remaining names drawn are placed on a waiting list in the order that the names are drawn PCA will begin notifying accepted applicants during the week of April 8th 2013 Students admitted into the school will be notified as well as students who are placed on a waiting list
If an additional vacancy occurs before the start of school or during the school year the student with the lowest number on the waiting list will be offered enrollment and that name will be removed from the waiting list If an application is received after the enrollment period the applicants name will be placed on the waiting list in the order the application is received In order to accommodate our families if more than one student on the waiting list has a sibling attending PCA a drawing will be held between the eligible siblings to determine admission
Pineywoods Academy does not discriminate on acceptance into the school based on gender national origin ethnicity religion disability academics artistic or athletic ability or the district the child would otherwise attend
Pineywoods Academy may choose to deny admission to students with a documented history of criminal offense juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111(a)(6)
This policy can be accessed from the PCA website at
httpwwwpineywoodsacademyorgadmissionspolicy
eiA Attachment 4 spoundf
AsSfr com
m Student Enrollment Application ypOr 1Pineywoods Community Academy Charter School
2013-2014 School Year
5WshyVS
H
DATE Completed_
Student Information
Students LegalName First Middle Last (as listed on birth certificate)
Gender malefemale Birth date (mdy)_ _ Birth City_ Birth State
Birth Country_ Grade Level for 2013-2014
Is this a repeatgrade YN
Students Street Address_
City State
County_ _Zip_ _Social Security _
Mailing Address (if different from above)
Street City_ State Zip
School District ofResidence
Past EnrollmentDetails
Previous SchoolsAttended (most recentfirst)
School Name School Name
Address Address
City_ State _Zip_ City State _Zip_
Phone _Dates of Attendance Phone _Dates of Attendance
Last Grade Completed atthis school _Last Grade Completed at this school
This school was a Check one This school was a Check one Public School Public School Private SchoolNon-religious Affiliated Private School Non-religious Affiliated Private School Religious Affiliated Private SchoolReligious Affiliated Charter School Charter School Home School Home School School outside of the Country School outsideof the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParcntGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach acopy of thecourt order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applvine to attend PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A
as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (ISS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information provided on this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsificatioti of these recordsfor anypurpose may be prosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
REVISED DURING CONTINGENCY PROCESS SEEINSERT
Section V Admission
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charter school establish a reasonable application deadlinefor the submission ofapplicationsfor admission
Beginning of Period End of Period (MonthDay) (MonthDay)
January 2 (or first day of school afterj March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013 q
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One p Yes
(bull No
C Not applicable (because lotteries are not utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
S- 3 1
V D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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 afirst-come first-served admission process when oversubscribed topublish a notice in a newspaper ofgeneral circulation not later than the seventh day before the application deadline
Type Below
Page 10
APPROVED DURING CONTINGENCYPROCESS
Section V Admissi
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charier school establish a reasonable application deadlinefor the submission of applicationsfor admission
Beginning of Period End of Period
(MonthDay) (MonthDay)
January 2 (or first day of school afteM March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One 0Yes
No
C Not applicable (because lotteries arenot utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
Students who are currently enrolled and return the Notice of Intent to Return form prior to April Is indicating they wish tocontinue enrollment at PCA are considered enrolled and exempt from an enrollment lottery it the number of applicants exceeds the number of available seats at a grade level In addition any siblings of currently enrolled studentsare given priority in admission to fill any available slots If more than one student at a grade level on the waiting list has a sibling attending PCA a drawing will be heldbetween the eligible siblings todetermine admission
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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
regwres a cAwer scroo W uses proceM Wien overjwkcrifW to a
notice in a newspaper of general circulation not later than the seventh day before the application deadline Type Below
Page 10
F If the school has a separate process for re-enrollment state the process and the timeline to be used
Type Below
Students currently enrolled in Pineywoods Community Academy will receive a Notice of Intent to Return form in early January Parents are to notify the school in writing through the return of the form no later than the last day of January if they intend for their child to attend Pineywoods Community Academy for the next school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currentlyenrolled student without an NIR will be removed from enrollment roster on the last day of March in order to make room for new enrollees Parents who do not return an NIR will be contacted to verify that they do not intend to enroll their student in PCA for the following year
G State the procedures for processing applications received once the application deadline has passed
Type Below
Applications received after the open enrollment date will be processed based on the date received and placed after the names of students chosen by lottery whose applications were received by the open enrollment deadline
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 beprecludedfrom enrolling due to the charter schoolsfailure to receive information requiredfor enrollmentfrom the students parent or guardian orprevious school See TEC sect25002 Type Below
Applicants are required to fill out an enrollment form and must provide current immunization information a birth certificate a copy of the social security card if available and a copy of the parents drivers license Students are not required to provide copies of transcripts or other academic records and 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
I The charter holder certifies that the non-discrimination statement required by TEC sect12111(a)(6) is printed in the schools admission policy TEC sect12111(6) requires that a charter schools admission policy include astatement 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
Check One (gtYes
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories of a criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC sect 12111(a)(6) Check Oneshy
^ Yes ( The school excludes such students or reserves the right to exclude such students from admissions)
pNo (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bull as Attachment 3 a current copy of the admission policy that incorporates the information provided in the aboveahswers to questions A through H and any other relevant information
bull as Attachment 4 a blank copy of the current admission application (ie the information requested when the student first seeks admission) and
bull as Attachment 5 a blank copy of the current enrollment form(s) (ie the information required once an applicant has been offered admission and is registering for enrollment)
Page 11
Attachment 3
Admissions Policy
2013-2014 Admissions Procedure Timeline
Students currently enrolled in Pineywoods Community Academy will receive a Notice ofIntent to Return form in early January Parents are to notify the school in writing through the return of the form no later than Wednesday January 16th 2013 if they intend for their child to attend Pineywoods Community Academy for the 2013-2014 school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currently enrolled student without an NIR will be removed from the 2013-2014 enrollment roster on March 29th 2013 in order to make room for new enrollees
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted during the week of April 1st 2013
During the lottery a name is drawn for each vacancy that is available Each eligible applicants name drawn will be offered admission into Pineywoods Community Academy to fill spaces in that grade level Once available spaces are exhausted the remaining names drawn are placed on a waiting list in the order that the names are drawn PCA will begin notifying accepted applicants during the week of April 8th 2013 Students admitted into the school will be notified as well as students who are placed on a waiting list
If an additional vacancy occurs before the start of school or during the school year the student with the lowest number on the waiting list will be offered enrollment and that name will be removed from the waiting list If an application is received after the enrollment period the applicants name will be placed on the waiting list in the order the application is received In order to accommodate our families if more than one student on the waiting list has a sibling attending PCA a drawing will be held between the eligible siblings to determine admission
Pineywoods Academy does not discriminate on acceptance into the school based on gender national origin ethnicity religion disability academics artistic or athletic ability or the district the child would otherwise attend
Pineywoods Academy may choose to deny admission to students with a documented history of criminal offense juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111(a)(6)
This policy can be accessed from the PCA website at
httpwwwpineywoodsacademyorgadmissionspolicy
eiA Attachment 4 spoundf
AsSfr com
m Student Enrollment Application ypOr 1Pineywoods Community Academy Charter School
2013-2014 School Year
5WshyVS
H
DATE Completed_
Student Information
Students LegalName First Middle Last (as listed on birth certificate)
Gender malefemale Birth date (mdy)_ _ Birth City_ Birth State
Birth Country_ Grade Level for 2013-2014
Is this a repeatgrade YN
Students Street Address_
City State
County_ _Zip_ _Social Security _
Mailing Address (if different from above)
Street City_ State Zip
School District ofResidence
Past EnrollmentDetails
Previous SchoolsAttended (most recentfirst)
School Name School Name
Address Address
City_ State _Zip_ City State _Zip_
Phone _Dates of Attendance Phone _Dates of Attendance
Last Grade Completed atthis school _Last Grade Completed at this school
This school was a Check one This school was a Check one Public School Public School Private SchoolNon-religious Affiliated Private School Non-religious Affiliated Private School Religious Affiliated Private SchoolReligious Affiliated Charter School Charter School Home School Home School School outside of the Country School outsideof the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParcntGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach acopy of thecourt order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applvine to attend PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A
as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (ISS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information provided on this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsificatioti of these recordsfor anypurpose may be prosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
APPROVED DURING CONTINGENCYPROCESS
Section V Admissi
A Specify the period during which applications for admission are accepted TEC sect12117 requires that a charier school establish a reasonable application deadlinefor the submission of applicationsfor admission
Beginning of Period End of Period
(MonthDay) (MonthDay)
January 2 (or first day of school afteM March 31 (last day of March)
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 Type Below
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted
during the week of April 1st 2013
C If the school utilizes a lottery when oversubscribed are any categories of applicants exempted from the lottery
Check One 0Yes
No
C Not applicable (because lotteries arenot utilized)
If Yes was indicated in C above state the categories of applicants that are exempted Type Below
Students who are currently enrolled and return the Notice of Intent to Return form prior to April Is indicating they wish tocontinue enrollment at PCA are considered enrolled and exempt from an enrollment lottery it the number of applicants exceeds the number of available seats at a grade level In addition any siblings of currently enrolled studentsare given priority in admission to fill any available slots If more than one student at a grade level on the waiting list has a sibling attending PCA a drawing will be heldbetween the eligible siblings todetermine admission
D If the school utilizes a lottery when oversubscribed specify the approximate date on which a lottery will be conducted
Approximate Date of Lottery (MonthDay)
April 1 (1st workday in April)
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 of the 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
regwres a cAwer scroo W uses proceM Wien overjwkcrifW to a
notice in a newspaper of general circulation not later than the seventh day before the application deadline Type Below
Page 10
F If the school has a separate process for re-enrollment state the process and the timeline to be used
Type Below
Students currently enrolled in Pineywoods Community Academy will receive a Notice of Intent to Return form in early January Parents are to notify the school in writing through the return of the form no later than the last day of January if they intend for their child to attend Pineywoods Community Academy for the next school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currentlyenrolled student without an NIR will be removed from enrollment roster on the last day of March in order to make room for new enrollees Parents who do not return an NIR will be contacted to verify that they do not intend to enroll their student in PCA for the following year
G State the procedures for processing applications received once the application deadline has passed
Type Below
Applications received after the open enrollment date will be processed based on the date received and placed after the names of students chosen by lottery whose applications were received by the open enrollment deadline
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 beprecludedfrom enrolling due to the charter schoolsfailure to receive information requiredfor enrollmentfrom the students parent or guardian orprevious school See TEC sect25002 Type Below
Applicants are required to fill out an enrollment form and must provide current immunization information a birth certificate a copy of the social security card if available and a copy of the parents drivers license Students are not required to provide copies of transcripts or other academic records and 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
I The charter holder certifies that the non-discrimination statement required by TEC sect12111(a)(6) is printed in the schools admission policy TEC sect12111(6) requires that a charter schools admission policy include astatement 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
Check One (gtYes
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories of a criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC sect 12111(a)(6) Check Oneshy
^ Yes ( The school excludes such students or reserves the right to exclude such students from admissions)
pNo (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bull as Attachment 3 a current copy of the admission policy that incorporates the information provided in the aboveahswers to questions A through H and any other relevant information
bull as Attachment 4 a blank copy of the current admission application (ie the information requested when the student first seeks admission) and
bull as Attachment 5 a blank copy of the current enrollment form(s) (ie the information required once an applicant has been offered admission and is registering for enrollment)
Page 11
Attachment 3
Admissions Policy
2013-2014 Admissions Procedure Timeline
Students currently enrolled in Pineywoods Community Academy will receive a Notice ofIntent to Return form in early January Parents are to notify the school in writing through the return of the form no later than Wednesday January 16th 2013 if they intend for their child to attend Pineywoods Community Academy for the 2013-2014 school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currently enrolled student without an NIR will be removed from the 2013-2014 enrollment roster on March 29th 2013 in order to make room for new enrollees
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted during the week of April 1st 2013
During the lottery a name is drawn for each vacancy that is available Each eligible applicants name drawn will be offered admission into Pineywoods Community Academy to fill spaces in that grade level Once available spaces are exhausted the remaining names drawn are placed on a waiting list in the order that the names are drawn PCA will begin notifying accepted applicants during the week of April 8th 2013 Students admitted into the school will be notified as well as students who are placed on a waiting list
If an additional vacancy occurs before the start of school or during the school year the student with the lowest number on the waiting list will be offered enrollment and that name will be removed from the waiting list If an application is received after the enrollment period the applicants name will be placed on the waiting list in the order the application is received In order to accommodate our families if more than one student on the waiting list has a sibling attending PCA a drawing will be held between the eligible siblings to determine admission
Pineywoods Academy does not discriminate on acceptance into the school based on gender national origin ethnicity religion disability academics artistic or athletic ability or the district the child would otherwise attend
Pineywoods Academy may choose to deny admission to students with a documented history of criminal offense juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111(a)(6)
This policy can be accessed from the PCA website at
httpwwwpineywoodsacademyorgadmissionspolicy
eiA Attachment 4 spoundf
AsSfr com
m Student Enrollment Application ypOr 1Pineywoods Community Academy Charter School
2013-2014 School Year
5WshyVS
H
DATE Completed_
Student Information
Students LegalName First Middle Last (as listed on birth certificate)
Gender malefemale Birth date (mdy)_ _ Birth City_ Birth State
Birth Country_ Grade Level for 2013-2014
Is this a repeatgrade YN
Students Street Address_
City State
County_ _Zip_ _Social Security _
Mailing Address (if different from above)
Street City_ State Zip
School District ofResidence
Past EnrollmentDetails
Previous SchoolsAttended (most recentfirst)
School Name School Name
Address Address
City_ State _Zip_ City State _Zip_
Phone _Dates of Attendance Phone _Dates of Attendance
Last Grade Completed atthis school _Last Grade Completed at this school
This school was a Check one This school was a Check one Public School Public School Private SchoolNon-religious Affiliated Private School Non-religious Affiliated Private School Religious Affiliated Private SchoolReligious Affiliated Charter School Charter School Home School Home School School outside of the Country School outsideof the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParcntGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach acopy of thecourt order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applvine to attend PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A
as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (ISS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information provided on this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsificatioti of these recordsfor anypurpose may be prosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
F If the school has a separate process for re-enrollment state the process and the timeline to be used
Type Below
Students currently enrolled in Pineywoods Community Academy will receive a Notice of Intent to Return form in early January Parents are to notify the school in writing through the return of the form no later than the last day of January if they intend for their child to attend Pineywoods Community Academy for the next school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currentlyenrolled student without an NIR will be removed from enrollment roster on the last day of March in order to make room for new enrollees Parents who do not return an NIR will be contacted to verify that they do not intend to enroll their student in PCA for the following year
G State the procedures for processing applications received once the application deadline has passed
Type Below
Applications received after the open enrollment date will be processed based on the date received and placed after the names of students chosen by lottery whose applications were received by the open enrollment deadline
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 beprecludedfrom enrolling due to the charter schoolsfailure to receive information requiredfor enrollmentfrom the students parent or guardian orprevious school See TEC sect25002 Type Below
Applicants are required to fill out an enrollment form and must provide current immunization information a birth certificate a copy of the social security card if available and a copy of the parents drivers license Students are not required to provide copies of transcripts or other academic records and 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
I The charter holder certifies that the non-discrimination statement required by TEC sect12111(a)(6) is printed in the schools admission policy TEC sect12111(6) requires that a charter schools admission policy include astatement 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
Check One (gtYes
ONo
J Does the admission policy either require or permit the school to exclude from admission all students with documented histories of a criminal offense a juvenile court adjudication or discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC sect 12111(a)(6) Check Oneshy
^ Yes ( The school excludes such students or reserves the right to exclude such students from admissions)
pNo (The school does not deny admission to such students based on their documented histories of misconduct)
Submit
bull as Attachment 3 a current copy of the admission policy that incorporates the information provided in the aboveahswers to questions A through H and any other relevant information
bull as Attachment 4 a blank copy of the current admission application (ie the information requested when the student first seeks admission) and
bull as Attachment 5 a blank copy of the current enrollment form(s) (ie the information required once an applicant has been offered admission and is registering for enrollment)
Page 11
Attachment 3
Admissions Policy
2013-2014 Admissions Procedure Timeline
Students currently enrolled in Pineywoods Community Academy will receive a Notice ofIntent to Return form in early January Parents are to notify the school in writing through the return of the form no later than Wednesday January 16th 2013 if they intend for their child to attend Pineywoods Community Academy for the 2013-2014 school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currently enrolled student without an NIR will be removed from the 2013-2014 enrollment roster on March 29th 2013 in order to make room for new enrollees
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted during the week of April 1st 2013
During the lottery a name is drawn for each vacancy that is available Each eligible applicants name drawn will be offered admission into Pineywoods Community Academy to fill spaces in that grade level Once available spaces are exhausted the remaining names drawn are placed on a waiting list in the order that the names are drawn PCA will begin notifying accepted applicants during the week of April 8th 2013 Students admitted into the school will be notified as well as students who are placed on a waiting list
If an additional vacancy occurs before the start of school or during the school year the student with the lowest number on the waiting list will be offered enrollment and that name will be removed from the waiting list If an application is received after the enrollment period the applicants name will be placed on the waiting list in the order the application is received In order to accommodate our families if more than one student on the waiting list has a sibling attending PCA a drawing will be held between the eligible siblings to determine admission
Pineywoods Academy does not discriminate on acceptance into the school based on gender national origin ethnicity religion disability academics artistic or athletic ability or the district the child would otherwise attend
Pineywoods Academy may choose to deny admission to students with a documented history of criminal offense juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111(a)(6)
This policy can be accessed from the PCA website at
httpwwwpineywoodsacademyorgadmissionspolicy
eiA Attachment 4 spoundf
AsSfr com
m Student Enrollment Application ypOr 1Pineywoods Community Academy Charter School
2013-2014 School Year
5WshyVS
H
DATE Completed_
Student Information
Students LegalName First Middle Last (as listed on birth certificate)
Gender malefemale Birth date (mdy)_ _ Birth City_ Birth State
Birth Country_ Grade Level for 2013-2014
Is this a repeatgrade YN
Students Street Address_
City State
County_ _Zip_ _Social Security _
Mailing Address (if different from above)
Street City_ State Zip
School District ofResidence
Past EnrollmentDetails
Previous SchoolsAttended (most recentfirst)
School Name School Name
Address Address
City_ State _Zip_ City State _Zip_
Phone _Dates of Attendance Phone _Dates of Attendance
Last Grade Completed atthis school _Last Grade Completed at this school
This school was a Check one This school was a Check one Public School Public School Private SchoolNon-religious Affiliated Private School Non-religious Affiliated Private School Religious Affiliated Private SchoolReligious Affiliated Charter School Charter School Home School Home School School outside of the Country School outsideof the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParcntGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach acopy of thecourt order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applvine to attend PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A
as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (ISS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information provided on this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsificatioti of these recordsfor anypurpose may be prosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
Attachment 3
Admissions Policy
2013-2014 Admissions Procedure Timeline
Students currently enrolled in Pineywoods Community Academy will receive a Notice ofIntent to Return form in early January Parents are to notify the school in writing through the return of the form no later than Wednesday January 16th 2013 if they intend for their child to attend Pineywoods Community Academy for the 2013-2014 school year Vacancies in each grade are determined based on the NIR forms returned In the admissions process siblings of returning students are given priority in admission to fill any available slots Any currently enrolled student without an NIR will be removed from the 2013-2014 enrollment roster on March 29th 2013 in order to make room for new enrollees
If the number of eligible applicants does not exceed the number of vacancies then all eligible applicants who applied during the enrollment time frame will be offered admission after the open enrollment period is completed The enrollment time frame is from Monday January 7th 2013 through Friday March 29th 2013 If there are more eligible applicants than available spaces in a grade then a lottery will be conducted during the week of April 1st 2013
During the lottery a name is drawn for each vacancy that is available Each eligible applicants name drawn will be offered admission into Pineywoods Community Academy to fill spaces in that grade level Once available spaces are exhausted the remaining names drawn are placed on a waiting list in the order that the names are drawn PCA will begin notifying accepted applicants during the week of April 8th 2013 Students admitted into the school will be notified as well as students who are placed on a waiting list
If an additional vacancy occurs before the start of school or during the school year the student with the lowest number on the waiting list will be offered enrollment and that name will be removed from the waiting list If an application is received after the enrollment period the applicants name will be placed on the waiting list in the order the application is received In order to accommodate our families if more than one student on the waiting list has a sibling attending PCA a drawing will be held between the eligible siblings to determine admission
Pineywoods Academy does not discriminate on acceptance into the school based on gender national origin ethnicity religion disability academics artistic or athletic ability or the district the child would otherwise attend
Pineywoods Academy may choose to deny admission to students with a documented history of criminal offense juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111(a)(6)
This policy can be accessed from the PCA website at
httpwwwpineywoodsacademyorgadmissionspolicy
eiA Attachment 4 spoundf
AsSfr com
m Student Enrollment Application ypOr 1Pineywoods Community Academy Charter School
2013-2014 School Year
5WshyVS
H
DATE Completed_
Student Information
Students LegalName First Middle Last (as listed on birth certificate)
Gender malefemale Birth date (mdy)_ _ Birth City_ Birth State
Birth Country_ Grade Level for 2013-2014
Is this a repeatgrade YN
Students Street Address_
City State
County_ _Zip_ _Social Security _
Mailing Address (if different from above)
Street City_ State Zip
School District ofResidence
Past EnrollmentDetails
Previous SchoolsAttended (most recentfirst)
School Name School Name
Address Address
City_ State _Zip_ City State _Zip_
Phone _Dates of Attendance Phone _Dates of Attendance
Last Grade Completed atthis school _Last Grade Completed at this school
This school was a Check one This school was a Check one Public School Public School Private SchoolNon-religious Affiliated Private School Non-religious Affiliated Private School Religious Affiliated Private SchoolReligious Affiliated Charter School Charter School Home School Home School School outside of the Country School outsideof the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParcntGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach acopy of thecourt order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applvine to attend PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A
as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (ISS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information provided on this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsificatioti of these recordsfor anypurpose may be prosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
eiA Attachment 4 spoundf
AsSfr com
m Student Enrollment Application ypOr 1Pineywoods Community Academy Charter School
2013-2014 School Year
5WshyVS
H
DATE Completed_
Student Information
Students LegalName First Middle Last (as listed on birth certificate)
Gender malefemale Birth date (mdy)_ _ Birth City_ Birth State
Birth Country_ Grade Level for 2013-2014
Is this a repeatgrade YN
Students Street Address_
City State
County_ _Zip_ _Social Security _
Mailing Address (if different from above)
Street City_ State Zip
School District ofResidence
Past EnrollmentDetails
Previous SchoolsAttended (most recentfirst)
School Name School Name
Address Address
City_ State _Zip_ City State _Zip_
Phone _Dates of Attendance Phone _Dates of Attendance
Last Grade Completed atthis school _Last Grade Completed at this school
This school was a Check one This school was a Check one Public School Public School Private SchoolNon-religious Affiliated Private School Non-religious Affiliated Private School Religious Affiliated Private SchoolReligious Affiliated Charter School Charter School Home School Home School School outside of the Country School outsideof the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParcntGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach acopy of thecourt order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applvine to attend PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A
as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (ISS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information provided on this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsificatioti of these recordsfor anypurpose may be prosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParcntGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach acopy of thecourt order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applvine to attend PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A
as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (ISS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information provided on this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsificatioti of these recordsfor anypurpose may be prosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A
as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (ISS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information provided on this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsificatioti of these recordsfor anypurpose may be prosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information provided on this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsificatioti of these recordsfor anypurpose may be prosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
L
Attachment 4 bullbull fcY
M -if Student Enrollment Application
Pineywoods Community Academy Charter School
2013-2014 School Year
ApPROe ieo Ddegv(
GcOAr4fGamp NCYpt
DATECompleted_ xdegcesgtS
Student Information
Students LegalNameFirst_ Middle Last (as listed onbirth certificate)
Gender malefemale Birth date (mdy)_ Birth City_ Birth State
Birth Couritry_ Grade Level for 2013-2014
Is this a repeat grade YN
Students Street Address_
City _State_
County_ _Zip_ _Social Security tf_
Mailing Address(if different from above)
Street City State Zip
School Districtof Residence
Past EnrollmentDetails
Previous SchoolsAttended (most recent first)
School Name School Name
Address Address
City State Zip_ City State Zip
Phone Dates of Attendance Phone Dates of Attendance
Last Grade Completedat this school Last Grade Completed at this school
This school was a Check one This school wasa Check one Public School Public School Private School Non-religious Affiliated Private SchoolNon-religious Affiliated Private School Religious Affiliated Private School Religious Affiliated Charter School Charter School Home School Home School School outside of the Country School outside of the Country
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
Student Name Date
Please note you must complete all sections for the enrollment form to be considered
ParentGuardianHome Information
(Circle One) Mother Guardian (Circle One) Father Guardian
Guardian Relationship Guardian Relationship
Name (Last First) Name (Last First)
Address Address
Home Phone Home Phone
Work Phone Work Phone
Cell Phone Cell Phone
Email Address Email Address
With whom does the student currently live Mother Father Both Guardian Other
Is a custody order or other court order in place that Pineywoods Community Academy Charter School should be aware of
Yes No if you checked Yes please attach a copy of the court order
Please list any siblings currently attending PCA Please include the 2013-2014 grade level for each sibling
Name Grade Name Grade_
Name Grade Name Grade_
Please list any siblings applying to attend PCA Please include the 2013-2014 grade level foreach sibling
Name Grade Name Grade_
Name Grade Name Grade
Check students ethnicity
Ethnicity African Hispanic Native American White (not of Asian -Pacific American Hispanic origin) Islander
2
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
Student Name Date
Pineywoods Community Academy may exclude from admission all students with a documented history of a criminal offense a juvenile court adjudication or serious discipline problems under TEC Chapter 37 Subchapter A as authorized by TEC 12111 (a)(6) Please answer the following questions
Has your child ever had any serious behavior problems at school Yes No
Has your child ever been suspended from school Yes No
Has your child ever been expelled from school Yes No
Has your child ever been placed in an alternative discipline setting such as In School Suspension (1SS) Disciplinary Alternative Educational Placement (DAEP) or Juvenile Justice Alternative Educational Placement ( JJAEP) Yes No
Special Services Special Education Information
Has your child ever been retained Yes No If yes which grade was your child retained in
Has your child ever had an Individual Education Plan (IEP) including public school preschool and private school Yes No Not sure
If yes please provide a copy of the latest IEP a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission Referral and Dismissal)
Has your child ever been evaluated for special services Yes_ No Not sure
Has your child attended any special education classes Yes No Not sure
Has your child ever participated in Physical Occupational SpeechLanguage Therapy or any other related services
Yes No Not sure_
If yes were any of the services provided by private therapists Please list therapists
Has your child ever participated in Adaptive PE Yes No Not sure
What was the most recent date your child received special education services Year Month Day
Has your child ever received accommodations under Section 504 Yes No Not sure
3
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
Student Name Date
I confirm that I have requested enrollment for (students name) at Pineywoods Community Academy Charter School for the 2013-2014 school year In addition to this completed and signed enrollment form other documents required to complete the enrollment process include
bull A legible copy of the students social security card bull A legible copy of the parents drivers license bull A legible copy of the students immunization record bull A legible copy of the birth certificate
The undersigned parentlegal guardian has read and understands the following 1) The enrollment of this student into Pineywoods Community Academy constitutes this students complete public education program 2) Completion of this enrollment process does not guarantee student enrollment in Pineywoods Community Academy Enrollment is based on space available 3) Applicants are not required to provide copies of transcripts or other academic records until after they are offered admission and are enrolled 4) A student may not be precluded from enrolling due to the charter schools failure to receive information for enrollment from the students parent or guardian or previous school 5) Pineywoods Community Academy does 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 6) Upon enrollment and acceptance into Pineywoods Community Academy parents will be asked to sign an Authorization for Release of Records Form so the school can request educational records from the students previous school if applicable
Ihereby certify that the information providedon this enrollmentform as well as other documentation provided is true correct and up to date Individuals who engage in the falsification of these recordsfor anypurpose may beprosecuted by the school to thefullest extent of the law
FatherLegal Guardian Signature Date
Please Print Name
MotherLegal Guardian Signature Date
Please Print Name
Pineywoods Community Academy 602 S Raguet Street Lufkin Texas 75904
936-634-5515 wwwpineywoodsacademyorg
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
Attachment 5 ^0cess
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and is registering for enrollment)
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
_ Attachment 5 $pound
The current admission application (Attachment 4 - the information requested when the student
first seeks admission) also serves as the enrollment form (the information required once the
applicant has been offered admission and lt5 registering for enrollment)
o
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
Section VI Special Education Assurances
The charter holder certifies that 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 that any future amendments to the laws regulations and rules will be incorporated and implemented
2 Signature of Charter Holder Boapound Chair Date
(Must sign in blue ink)
P r - 1V g lt 3 f o RECEIVED APR bull A
Printed Name of Charter Holder Board Chair
Page 12
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
Section VII Assurances Regarding Charter Schools Serving Students at Residential Facilities
If the charter school is not currently approved to serve students at residential facilities please indicate NA 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 the following
Compliance with Special Education Requirements 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 that it provide a free and appropriate public education (FARE) in the least restrictive environment (ERE) to students with disabilities residing in RFs The charter holder further assures that it will provide or seek the provision of a FARE 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
Geographic Boundaries The charter holder assures that it will accept students who reside in the school district(s) that are within each new campuss geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program
Admissions 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 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) external auditor or other entity
Residential Facilities Monitoring (RFM) System The charter holder assures that it understands that pursuant to 19 Texas Administrative Code (TAG) sect971072 there is a specific system for monitoring school districts and charter schools that serve students with disabilities who reside in RFs The charter holder further assures that it understands that 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 that it may be subject to RFM intervention activities and on-site visits based upon a review of the data it reports or on random or other means of selection
Training The charter holder assures that all personnel involved with serving students with disabilities residing in an RF and personnel involved with reporting data in RF Tracker will receive training on the RFM system
Page 13
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
Section VII (Continued) Assurances Regarding Charter Schools Serving Students at Residential Facilities
The charter holder assures that this assurance 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
Signature of Charter Holder Boar^Chair Date (Must sign in blue ink)
RECBVE0 D r t V e a l o ^
Printed Name of Charter Holder Board Chair
Please write NA in the signature line if the charter does not serve students at residential facilities
Page 14
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
Section VIII BilingualESL Section 504 and Dyslexia Assurances
TEC Chapter 29 Subchapter B TECsect12104(b)(2)(G) and 19 TACsectsect891201-1265 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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students
Check One _r(bull Yes
r No
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 that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504 Check One
(bull Yes
CNo
TECsect38003 TECsect12104(b)(2)(E) 19 TACsect7428 and Section 504 of the Rehabilitation Act of 1973 29 USC sect794 require charter schools to identify students with dyslexia or related disorders and to provide appropriate educational services
C The charter holder certifies that it has policies and procedures in place that ensure that it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students with dyslexia or related disorders
Check One _ bdquo r(bullYes
C No
I further certify that any future amendments to the laws regulations and rules will be incorporated and implemented
(Must sign in blue ink)
received 0 z c i l l j
O r l Z C 4 j D
Printed Name of Charter Holder Board Chair
Page 15
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
r
Section IX Fingerprinting and Criminal Record Check Assurance
The charter holder certifies that 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 of Criminal Procedures
Additionally the charter holder confirms that all current fingerprinting and criminal record checks are 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 are not on the board in compliance with TEC sectsect121059 220832-220835
(Must sign in blue ink)
Qr VltfCy ( (arai o
RECEIVED APR o 2 2013 Printed Name of Charter Holder Board Chair
Page 16
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
f
Section X Certificate of Acknowledgement
This section 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 of education 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 of education for consideration of the renewal of the charter
Members are to sign the acknowledgement during an open meeting therefore the date next to each signature must be the same
Typed Name (Type name next to corresponding Signature
signature) (Must sign in blue ink)
Dr Neal Naranjo March 4 2013
Mrs Linda Robbing March 42013
Ms Louise LaVane March 4 2013
Mr Charlie Grumbles March 42013(VAX-Mr Joe Douglas III v- March 4 2013
Mr RL Kuykendall March 42013 A Dr Josefa Santiago March 42013
t-yV
RECEIVED APR 0 2 2B13
Page 17
V
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
TM
TEXAS EDUCATION AGENCY 1701 North Congress Ave bull AustinTexas 78701-1494 bull 512 463-9734 bull 512 463-9838FAX bull wwwteastatetxus
Michael LWilliams CommissionerCharter Renewal Contract
April 2 2014
Dr Jennings Naranjo Board Chair Pineywoods Community Academy PO Box 1743 Lufkin Texas 75902
Re Charter Renewal Contract for Pineywoods Community Academy (CDN 003801)
Dear Dr Naranjo
I am pleased to inform you that the charter renewal is approved for Pineywoods Community Academy with a contract ending date of July 31 2023 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 2013 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 it 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 the authority and responsibility granted 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
RECEIVED MM 1 2 2tm
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
Dr Jennings Naranjo Board Chair Pineywoods Community Academy Charter Contract Renewal Page 2 of 2
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 longer an eligible entity within the meaning of TEC sect12101(a) the charter contract shall be rendered void and it shall automatically return to the commissioner of education (COE) without any further action
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
To acknowledge acceptance of this renewed contract and to finalize the contract renewal 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 BuildingRoom 5-107 1701 North Congress Avenue
Austin Texas 78701-1494
The charter holder should keep a copy of this document for its files Please contact the Division of Charter School Administration at (512) 463-9575 with any questions
Sincerely
Michael Williams Commissioner of Education
MWmg RECEIVED MAY 1 2 Z
cc Mr Bruce Marchand Superintendent
I the undersigned hereby certify that the governing body of the charter holder has accepted and agreed to the charter renewal agreement for Pineywoods Community Academy as outlined in the foregoing letter and has authorized me to sign below
Agrc
Dr DateBoard Chair Pineywoods Community Academy
